200.000ADULT DEVELOPMENTAL DAY TREATMENT (ADDT) GENERAL INFORMATION201.000 Arkansas Medicaid Participation Requirements for Adult Developmental Day Treatment (ADDT) Providers
Adult Developmental Day Treatment (ADDT) providers must meet the Provider Participation and enrollment requirements contained within Section 140.000 of this manual as well as the following criteria to be eligible to participate in the Arkansas Medicaid Program:
A. Each provider of ADDT must be licensed as an Adult Developmental Day Treatment clinic by the Division of Provider Services and Quality Assurance (DPSQA), as the regulatory entity governing licensure.B. A copy of the current license must accompany the provider application and the Medicaid contract.201.100 Providers of ADDT Services in Arkansas and Bordering States ADDT providers in Arkansas and within fifty (50) miles of the state line in the six bordering states (Louisiana, Mississippi, Missouri, Oklahoma, Tennessee and Texas) may be enrolled as ADDT providers if they meet all Arkansas Medicaid participation requirements.
ADDT providers may furnish and claim reimbursement for covered services in the Arkansas Medicaid Program subject to benefit limits and coverage restrictions set forth in this Manual. Claims must be filed according to the specifications in this Manual.
201.200 ADDT Providing Occupational, Physical, or Speech Therapy Optional services available through ADDT include occupational, physical and speech therapy and evaluation as a component of the individual program plan (IPP) for an individual accepted for adult developmental disabilities services. Therapy services are not included in the core services and are provided in addition to the core services (see Sections 214.210 and 215.200 of this manual for additional requirements for provision of therapy services)
An ADDT facility may contract with or employ qualified therapy practitioners. The individual therapy practitioner who actually performs a service on behalf of the ADDT facility must be identified on the claim as the performing provider when the ADDT facility bills for that service. This action is taken in compliance with the federal Improper Payments Information Act of 2002 (IPIA), Public Law 107-300 and the resulting Payment Error Rate Measurement (PERM) program initiated by the Centers for Medicare and Medicaid Services (CMS).
If the facility contracts with a qualified therapy practitioner, the criteria for group providers of therapy services apply (See Section 201.100 of the Occupational, Physical, Speech Therapy Services manual) The qualified therapy practitioner who contracts with the facility must be enrolled with Arkansas Medicaid. The contract practitioner who performs a service must be listed as the performing provider on the claim when the facility bills for that service.
If the facility employs a qualified therapy practitioner, that practitioner has the option of either enrolling with Arkansas Medicaid or requesting a Practitioner Identification Number (View or print form DMS-7708). The employed practitioner who performs a service must be listed as the performing provider on the claim when the facility bills for that service.
202.000 Documentation Requirements202.100 Documentation Requirements for All Medicaid Providers See Section 141.000 for the documentation that is required for all Medicaid providers.
202.200 Clinical Records ADDT Providers Must KeepA. Providers must establish and maintain medical records for each beneficiary that include documentation of medical necessity for ADDT services and the beneficiary's individual program plan (IPP).B. Sufficient written documentation for each beneficiary record must support the medical necessity of each of the services provided. This requirement applies to core services and optional services. Refer to Sections 214.000 through 216.200 of this manual for descriptions of services.C.Dailyservice documentation for each ADDT beneficiary must, at a minimum, include the following items.1. Thespecific services furnished,2. The date and actual beginning and ending time of day the services were performed,3. Name(s) and title{s) of the person(s) providing the service(s), and4. The relationship of the services to the goals and objectives described in the beneficiary's IPP.D. The record must include weekly progress notes, signed or initialed by the person(s) providing the service(s), describing each beneficiary's status with respect to his or her goals and objectives.202.300 Electronic Signatures Medicaid will accept electronic signatures provided the electronic signatures comply with Arkansas Code § 25-31-103 et seq.
210.000PROGRAM COVERAGE211.000 Introduction Medicaid assists eligible individuals to obtain medical care in accordance with the guidelines specified in Section I of this manual. Reimbursement may be made for covered adult day treatment services provided to Medicaid beneficiaries at qualified provider facilities.
211.100 Developmental Disability Diagnosis In order to receive ADDT services, a beneficiary must have a developmental disability diagnosis that originated before the age of 22.
A. A developmental disability is: 1. Is attributable to intellectual disability, cerebral palsy, spina bifida, Down syndrome, epilepsy or autism spectrum disorder. a. Intellectual Disability - As established by scores of intelligence which fall two or more standard deviations below the mean of a standardized test of intelligence administered by a legally qualified professional;b. Cerebral Palsy - As established by the results of a medical examination provided by a licensed physician;c. Spina bifida - As established by the results of a medical examination provided by a licensed physician.d. Down syndrome - As established by the diagnosis of a licensed physician.e. Epilepsy - As established by the results of a neurological and/or licensed physician;f. Autism Spectrum Disorder - As established by the results of a team evaluation including at least a licensed physician and a licensed psychologist and a licensed Speech Pathologist; NOTE: Each of these six conditions is sufficient for determination of eligibility independent of each other. This means that a person who is intellectually disabled does not have to have a diagnosis of autism spectrum disorder, epilepsy, spina bifida, down syndrome, or cerebral palsy. Conversely, a person who has autism spectrum disorder, cerebral palsy, epilepsy, spina bifida, or Down syndrome does not have to have an intellectual disability to receive services.
2. Is attributable to any other condition of a person found to be closely related to intellectual disability because it results in impairment of general intellectual functioning or adaptive behavior similar to those of persons with intellectual disability or requires treatment and services similar to those required for such persons. This determination must be based on the results of a team evaluation including at least a licensed Physician and a licensed Psychologist. a. tn the case of individuals being evaluated for service, eligibility determination shall be based upon establishment of intelligence scores which fall two or more standard deviations below the mean of a standardized test of intelligence OR, is attributable to any other condition found to be closely related to an intellectual disability because it results in impairment of general intellectual functioning or adaptive behavior similar to those of persons with an intellectual disability, or requires treatment and services similar to those required for such persons.b. Adults will be eligible for services If their I.Q. scores fall two or more standard deviations below the mean of a standardized test3. Is attributable to dyslexia resulting from intellectual disability, cerebral palsy, epilepsy spina bifida, Down syndrome or autism spectrum disorder as established by the results of a team evaluation including at least a licensed Physician and a licensed Psychologist. NOTE: In the case of individuals being evaluated for service, eligibility shall be based upon their condition closely related to an intellectual disability by virtue of their adaptive behavior functioning.
B. The disability has continued or is expected to continue indefinitely; andC. The disability constitutes a substantial handicap to the beneficiary's ability to function without appropriate support services.212.000 Scope A. ADDT services in qualified facilities may be covered only when they are: 1. Provided to outpatients who have been diagnosed with a developmental disability, and are either 21 and older or between 18-21 years of age with a diploma or certificate of completion.2. Determined medically necessary for the beneficiary.3. Provided pursuant to a written prescription by a physician, and4. Provided in accordance with a written, individual program plan (IPP).B. Outpatients are individuals who travel to and from a treatment site on the same day, who do not reside in an intermediate care facility for individuals with developmental disabilities (ICF/IDD) and who are not inpatients of a hospital.C. Please refer to Sections 215.000 through 216.100 of this manual for details regarding medical necessity and individual program plans (IPP).213.000 Non-Covered Services Non-covered services include, but are not limited to:
A. Assessment services and adult habilitative services less than 1 hour in length,B. Supervised living services,C. Educational services, andD. Services to inpatients. An AODT clinic must provide only those services that DPSQA licenses the ADDT clinic to provide.
214.000 Coverage of ADDT Services 214.100 ADDT Core Services ADDT services may be furnished only by DPSQA licensed, comprehensive adult developmental day treatment centers offering as core services:
B. Adult Habilitative Services.214.110 Assessment Services Assessment services are covered separately from ADDT habilitative services. Assessment services are reimbursed on a per unit basis with one unit equal to one hour of service. The length of the service may not exceed one unit per date of service. The billable unit includes time spent administering the test, time spent scoring the test and/or time spent writing a test report. Assessment services are covered once each calendar year, if deemed medically necessary.
214.120 Adult Habilitative Services A. Adult habilitative services are instruction in areas of cognition, communication, social/emotional, motor, and adaptive (including self-care); or to reinforce skills learned and practiced in occupational, physical or speech therapy. These services must be based on the goals and objectives of the client's individual program plan (IPP). (Refer to Section 215.000 of this manual.)B. Medicaid covers adult habilitative services only in clinical settings licensed by DPSQA and enrolled in Medicaid.C. Adult habilitative services are provided to adults who have been diagnosed with a developmental disability. Qualifying individuals must be between ages 18 and 21 with a diploma or certificate of completion, or age 21 and older.D. ADDT providers must ensure that a noon meal is available to each Medicaid beneficiary who receives at least four hours of adult habilitative services in a day and who is unable to provide his or her own meal on that date of service. 1. When being responsible for providing his or her own meal is a component of a beneficiary's IPP, the provider may request the beneficiary furnish the meal.2. A beneficiary may not be charged for a meal the facility provides, whether or not providing his or her own meal is included in the client's IPP.3. If a beneficiary who is responsible for providing his or her own meal fails to do so, the provider must furnish a meal for that individual if he or she receives more than four (4) hours of habilitative services that day.E. Adult habilitative services may include prevocational services that prepare a beneficiary for employment. Prevocational services: 1. May not be job-task oriented, but a. May include such habituation goals as compliance, attending, task completion, problem solving and safety, and b. May be provided only to persons who are not expected to be able to join the general work force or to participate in a transitional sheltered workshop within one year (excluding supported employment programs).2. May not be primarily directed at teaching specific job skills.3. Must be listed in the IPP as adult habilitative services and may not address explicit employment objectives.4. The person's compensation must be less than 50% of minimum wage in order for the training to qualify as prevocational services. Commensurate wage must be paid under a current Wage and Hour Sheltered Workshop Certificate.5. Documentation must be maintained in each person's file showing that the services are not available under a program funded under Section 110 of the Rehabilitation Act of 1973, as amended, or the Individuals with Disabilities Education Act (IDEA) of 1997.F. Adult habilitative services are established on a unit-of-service basis. Each unit of service equals one (1) hour in the facility with a maximum of five (5) units reimbursable per day. Time spent in transit from the person's place of residence to the provider facility and from the facility back to the person s place of residence is not included in the unit of service calculation215.000 Individual Program Plan (IPP) For each beneficiary who enters the ADDT Program, an individual program plan (IPP) must be developed. This consists of a written, individualized plan to improve or maintain the beneficiary's condition based upon evaluation of the beneficiary. The IPP must contain a written description of the treatment objectives for the beneficiary. It also must describe:
A. The treatment regimen-the specific services, therapies and activities that will be used to achieve the treatment objectives.B. A schedule for service delivery-this includes the frequency and duration of each type of service.C. The job titles or credentials of personnel that will furnish each service,D. A tentative schedule for completing revaluations of the beneficiary's condition and updating the IPP. The IPP must be authorized by the physician determining that ADDT services are medically necessary. The physician's original personal signature and the date signed must be recorded on the IPP. Delegation of this function or a stamped signature is not allowed.
216.000 ADDT Optional Services216.100 Occupational, Physical and Speech Therapy Optional services available through ADDT include occupational, physical and speech therapy and assessment as an essential component of the individual program plan (IPP) for an individual accepted for adult developmental disabilities services.
A. The ADDT client's primary care physician (PCP) or attending physician must refer a client for assessment for occupational, physical or speech therapy services.B. If the beneficiary qualifies for services based on the assessment, the ADDT client's primary care physician (PCP) or attending physician must prescribe occupational, physical and/or speech therapy services. The prescribed therapy must be included in the individual's ADDT IPP. A copy of the prescription must be maintained in the beneficiary's records. The original prescription is to be maintained by the prescribing physician. After the initial referral and initial prescription, subsequent referrals and prescriptions forcontinued therapy may be made at the same time. Medicaid will accept an electronic signature provided it is in compliance with Arkansas Code 25-31-103.C. Therapies in the ADDT Program may be provided only to individuals whose IPP includes adult nabilitative services. Medicaid does not cover optional therapy services furnished by an ADDT provider as "stand-alone" services. To ensure quality care, group therapy sessions are limited to no more than four persons in a group. 1. When an ADDT provider renders therapy services in conjunction with an ADDT core service, therapy services must be billed by the ADDT provider according to billing instructions in Section II of thismanual.2. ADDT providers may not bill under the Medicaid Occupational, Physical and Speech Therapy Program for therapy services available in the ADDT Program and provided to ADDT clients.3. Therapy services may not be provided during the same time period ADDT core services are provided.D. Arkansas Medicaid applies the following therapy benefits to all therapy services provided In the ADDT program: 1. Medicaid will reimburse up to four (4) occupational, physical and speech therapy evaluation units (1 unit = 30 minutes) per discipline, per state fiscal year (July 1 through June 30) without authorization. Additional evaluation units for beneficiaries under age 21 will require an extended therapy request.2. Medicaid will reimburse up to six (6) occupational, physical and speech therapy units (1 unit = 15 minutes) per week, per discipline, without prior authorization.E. Therapy services carried out by an unlicensed therapy student may be covered only when the following criteria are mef1. Therapies performed by an unlicensed student must be under the direction of a licensed therapist and the direction is such that the licensed therapist is considered to be providing the medical assistance2. The licensed therapist must be present and engaged in student oversight during the entirety of any encounter.F. All therapy services must be provided and billed in accordance with the Arkansas Medicaid Provider Manual for Occupational, Physical and Speech Therapy Services.216.200 Nursing Services Nursing services are available for beneficiaries who are medically fragile, have complex health needs, or both, if prescribed by the beneficiary's PCP and prior authorized, in accordance with this manual.
Nursing services that are needed by a beneficiary and that can only be performed by a licensed nurse may be billed by an ADDT with prior authorization. For the purposes of this manual, nursing services are defined as the following, or similar, activities:
1. Assisting ventilator-dependent beneficiaries;2. Tracheostomy: suctioning and care;3. Feeding tube: feeding, care and maintenance;5. Breathing treatments; and6. Monitoring of vital statistics, including diabetes sugar checks, insulin, blood draws and pulse ox; and7. Administration of medication. Reimbursable nursing services do not include the taking of temperature, or provision of standard first aid.
Administration of medication alone does not qualify a beneficiary for nursing services.
Nursing services must be performed by a licensed Registered Nurse or Licensed Practical Nurse, and must be within the nurse's scope of practice as set forth by the Arkansas State Board of Nursing.
All nursing services must be prior authorized. To establish medical necessity for nursing services, the beneficiary must have a medical diagnosis and a comprehensive nursing evaluation approved by a PCP that designates the need for nursing services. The evaluation must specify what the needed nursing services are, and the number of nursing units needed per day.
217.000 Establishing Medical Necessity for ADDT217.100 Establishing Medical Necessity for Core Services Reimbursement for ADDT services will be approved only when the individual's attending physician has determined ADDT core services are medically necessary.
A. The physician must identify the individual's medical needs or medical or developmental diagnosis that habilitative services can address.B. To initiate ADDT services the individual's physician must issue a written prescription. The prescription for ADDT is valid for one year unless the prescribing physician specifies a shorter period of time. The prescription must be renewed at least once a year for services to continue.C. Each prescription must be dated and signed by the physician with his or her original signature to be considered a valid prescription.D. It is presumed that no more than eight (8) hours of ADDT core services and optional services combined per day is medically necessary.217.200 Establishing Medical Necessity for Occupational, Physical and Speech Therapy Services
Occupational, physical, and speech therapy services must be medically necessary to the treatment of the beneficiary's developmental disability, in accordance with the Medicaid Provider Manual for Occupational, Physical, and Speech Therapy Services, Section II. A diagnosis alone is not sufficient documentation to support the medical necessity of therapy.
220.000PRIOR AUTHORIZATIONPrior authorization is not required for ADDT core service or for the first ninety (90) minutes per week of each therapy discipline: occupational, physical and speech therapy services.
All nursing services must be prior authorized.
230.000REIMBURSEMENT AND RECOUPMENT231.000 Method of Reimbursement The reimbursement methodology for ADDT services is a "fee schedule" methodology. Under the fee schedule methodology, reimbursement is made at the lower of the billed charge for each procedure or the maximum allowable for each procedure. The maximum allowable fee for a procedure is the same for alt ADDT providers.
231.100 Fee Schedules Arkansas Medicaid provides fee schedules on the Arkansas Medicaid website. The fee schedule link is located at https://www.medicaid.state.ar.us under the provider manual section. The fees represent the fee-for-service reimbursement methodology.
Fee schedules do not address coverage limitations or special instructions applied by Arkansas Medicaid before final payment is determined-Procedure codes and/or fee schedules do not guarantee payment, coverage or amount allowed. Information may be changed or updated at any time to correct a discrepancy and/or error. Arkansas Medicaid always reimburses the lesser of the amount billed or the Medicaid maximum.
232.000 Retrospective Reviews Arkansas Medicaid conducts retrospective reviews of all non-prior authorized ADDT services. The purpose of the retrospective review is to promote the effective, efficient, and economical delivery of health care services.
The Quality Improvement Organization (QIO) under contract to the Arkansas Medicaid program performs retrospective reviews of medical records to determine if services delivered and reimbursed by Medicaid meet medical necessity requirements as outlined in the Medicaid Provider Manual.
233.000 Recoupment The Division of Medical Services (DMS). Utilization Review Section (UR) is required to initiate the recoupment process for all services denied by the Arkansas Medicaid programs' contracted
Quality Improvement Organization (QIO) for retrospective therapy reviews for not meeting the medical necessity requirement. Based on QIO findings during retrospective reviews, UR will initiate recoupment as appropriate.
DMS will send the provider an Explanation of Recoupment Notice that will include the claim date of service, Medicaid beneficiary name and ID number, service provided, amount paid by Medicaid, amount to be recouped, and the reason the claim has been denied.
234.000 Administrative Reconsideration When a provider or beneficiary wishes to ask for administrative reconsideration of a DH3 decision, he or she should follow the procedure laid out in the Medicaid Provider Manual, Section 161.200.
234.100 Appeal Process When the Division of Medical Services (DMS) denies coverage of services, the beneficiary or the provider may request a fair hearing to appeal the denial of services from the Department of Health and Human Services. To do so, the beneficiary or provider should follow the procedures laid out in the Medicaid Provider Manual, Sections 160.000 & 190.000.
234.200 Utilization Review A. The Utilization Review Section of the Arkansas Medicaid Program has the responsibility for assuring quality medical care for Medicaid beneficiaries and for protecting the integrity of state and federal funds supporting the Medical Assistance Program. Those responsibilities are mandated by federal regulations.B. The Utilization Review team shall: 1. Conduct on-site medical audits for the purpose of verifying the nature and extent of services paid for by the Medicaid Program,2. Research all inquiries from beneficiaries in response to the Explanation of Medicaid Benefits and3. Retrospectively evaluate medical practice patterns and providers' patterns by comparing each provider's pattern to norms and limits set by all the providers of the same specialty.240.000BILLING PROCEDURES241.000 Introduction To Billing ADDT service providers use form CMS-1500 to bill the Arkansas Medicaid Program for services provided to Medicaid beneficiaries. Each claim may contain charges for only one beneficiary,
Section III of this manual contains information about Provider Electronic Solutions (PES) and other available options for electronic claim submission.
242.000 CMS-1500 Billing Procedures242.100 ADDT Core Services Procedure Cades ADDT core services are reimbursable on a per unit basis. Partial units are not reimbursable. Service time less than a full unit of service may not be rounded up to a full unit of service and may not be carried over to the next service date.
Procedure Code | Required Modifier | Description |
T1015 | U6, UA | Adult Habilitative Services (1 unit equals 1 hour of sen/ice; maximum of 5 cumulative units per day.) |
T1023 | U6, UA | Diagnosis and Evaluation Services (not to be billed for therapy evaluations) (1 unit equals 1 hour; maximum of 1 unit per day, once per year.) |
T1002 | U6.UB | Nursing Services (must be prior authorized; 1 unit equals 15 minutes of service) |
99367 | U6, UC | Treatment Plan Development. Plan must include short and long term goals and objectives and the activities to meet those goals and objectives (1 unit equals 1 event; limit of 1 unit annually) |
242.110 Occupational Physical and Speech Therapy Procedure Codes ADDT therapy services may be provided only outside the time ADDT core services are furnished. The following procedure codes must be used for therapy services in the ADDT Program for Medicaid beneficiaries of all ages.
A. Occupational Therapy Procedure Codes Procedure Code | Required Modifier(s) | Description |
97003 | Evaluation for occupational therapy (30-minute unit; maximum of 4 units per state fiscal year, July 1 through June 30) | |
97150 | U1.UB | Group occupational therapy by occupational therapy assistant (15-minute unit; maximum of 4 units per day, maximum of 4 clients per group) |
97150 | U2 | Group occupational therapy by Occupational Therapist (15-minute unit; maximum of 4 units per day, maximum of 4 clients per group) |
97530 | - | Individual occupational therapy by Occupational Therapist (15-minute unit; maximum of 4 units per day) |
97530 | UB | Individual occupational therapy by occupational therapy assistant (15-minute unit; maximum of 4 units per day) |
B. Physical Therapy Procedure Codes Procedure Code | Required Modifier(s) | Description |
97001 | - | Evaluation for physical therapy (30-minute unit; maximum of 4 units per state fiscal year, July 1 through June 30) |
97110 | - | Individual physical therapy by Physical Therapist (15-minute unit; maximum of 4 units per day) |
97110 | UB | Individual physical therapy by physical therapy assistant (15-minute unit; maximum of 4 units per day) |
97150 | - | Group physical therapy by Physical Therapist (15-minute unit; maximum of 4 units per day, maximum of 4 clients per group) |
97150 | UB | Group physical therapy by physical therapy assistant (15-minute unit; maximum of 4 units per day, maximum of 4 clients per group) |
C. Speech Therapy Procedure Codes Procedure Code | Required Modifier(s) | Description |
92521 | UA | *'*Evaluation of speech fluency (e.g. stuttering, cluttering) (maximum of four 30-minute units per state fiscal year, July 1 through June 30) |
92522 | UA | *"*Evaluation of speech sound production (e.g. articulation, phonological process, apraxia, dysarthria) (maximum of four 30-minute units per state fiscal year, July 1 through June 30) |
92523 | UA | *"*Evaluation of speech sound production (e.g. articulation, phonological process, apraxia, dysarthria) with evaluation of language comprehension and expression (e.g. receptive and expressive language) (maximum of four 30-minute units per state fiscal year, July 1 through June 30) |
92524 | UA | *"*Behavioral and qualitative analysis of voice and resonance (maximum of four 30-minute units per state fiscal year, July 1 through June 30) |
92507 | - | Individual speech session by Speech Therapist (15-minute unit; maximum of 4 units per day) |
92507 | UB | Individual speech therapy by speech language pathology assistant (15-minute unit; maximum of 4 units per day) |
92508 | - | Group speech session by Speech Therapist (15-minute unit; maximum of 4 units per day, maximum of 4 clients per group) |
92508 | UB | Group speech therapy by speech language pathology assistant (15-minute unit; maximum of 4 units per day, maximum of 4 clients per group) |
NOTE: A(...) This symbol, along with text In parentheses, Indicates the Arkansas
Medicaid description of the service. When using a procedure code with this symbol, the service must meet the indicated Arkansas Medicaid description.
242.200 National Place of Service (POS) Codes Listed below is the National Place of Service (POS) Code for ADDT procedures.
Electronic and paper claims now require the same National Place of Service code.
Place of Service | POS Codes |
Day Care Facility/ADDT Clinic | 99 |
242.300Billing Instructions- Paper Only The Arkansas Medicaid fiscal agent offers providers several options for electronic billing. Therefore, claims submitted on paper are lower priority and are paid once a month. The only claims exempt from this rule are those that require attachments or manual pricing.
Bill Medicaid for professional services with form CMS-1500. The numbered items in the following instructions correspond to the numbered fields on the claim form. View a sample form CMS-1500.
Carefully follow these instructions to help the Arkansas Medicaid fiscal agent efficiently process claims. Accuracy, completeness, and clarity are essential. Claims cannot be processed if necessary information is omitted.
Forward completed claim forms to the Claims Department. View or print the Claims Department contact information,
NOTE: A provider delivering services without verifying beneficiary eligibility for each date of service does so at the risk of not being reimbursed for the services.
242.310 Completion of the CMS-1500 Claim Form Field Name and Number | Instructions for Completion |
1. (type of coverage) 1a. INSUREDS I.D. NUMBER (For Program in Item 1) | Not required. Beneficiary's or participant's 10-digit Medicaid identification number. |
2. PATIENTS NAME (Last Name, First Name, Middle Initial) | Beneficiary's or participant's last name and first name |
3. PATIENT'S BIRTH DATE SEX | Beneficiary's or participant's date of birth as given on the individual's Medicaid identification card, Format: MM/DD/YY. Check M for male or F for female- |
4. INSURED'S NAME (Last Name, FirstName, Middle Initial) | Required if insurance affects this claim. Insured's last name, first name, and middle initial |
5. PATIENT'S ADDRESS (No., Street) CITY STATE ZIP CODE | Optional. Beneficiary s or participant s complete mailing address (street address or post office box) Name of the city in which the beneficiary or participant resides. Two-letter postal code for the state in which the beneficiary or participant resides. Five-digit zip code; nine digits for post office box. |
TELEPHONE (Include Area Code) | The beneficiary's or participant's telephone number or the number of a reliable message/contact/ emergency telephone. |
6. PATIENT RELATIONSHIP TO INSURED | If insurance affects this claim, check the box indicating the patient's relationship to the insured. |
7. INSURED'S ADDRESS (No., Street) CITY STATE ZIP CODE TELEPHONE (Include Area Code) | Required if insured's address is different from the patient's address. |
8. RESERVED | Reserved for NUCC use. |
9. OTHER INSUREDS NAME (Last name, First Name, Middle Initial) a. OTHER INSURED'S POLICY OR GROUP NUMBER b. RESERVED SEX c. RESERVED d. INSURANCE PLAN NAME OR PROGRAM NAME | If patient has other insurance coverage as indicated in Field 11d, the other insured's last name, first name, and middle initial. Policy and/or group number of the insured individual. Reserved for NUCC use. Not required. Reserved for NUCC use. Name of the insurance company. |
10. IS PATIENT'S CONDITION RELATED TO: a. EMPLOYMENT? (Current or Previous) b. AUTO ACCIDENT? PLACE (State) c. OTHER ACCIDENT? d. CLAIMS CODES | Check YES or NO. Required when an auto accident is related to the services. Check YES or NO. If 10b is YES, the two-letter postal abbreviation for the state in which the automobile accident took place. Required when an accident other than automobile is related to the services. Check YES or NO. The "Claim Codes" identify additional information about the beneficiary's condition or the claim. When applicable, use the Claim Code to report appropriate claim codes as designated by the NUCC. When required to provide the subset of Condition Codes, enter the condition code in this field. The subset of approved Condition Codes is found at www.nucc.org under Code Sets. |
11. INSUREDS POLICY GROUP OR FECA NUMBER | Not required when Medicaid is the only payer. |
a. INSURED'S DATE OF BIRTH SEX b. OTHER CLAIM ID NUMBER c. INSURANCE PLAN NAME OR PROGRAM NAME d. IS THERE ANOTHER HEALTH BENEFIT PLAN? | Not required. Not required, Not required. Not required. When private or other insurance may or will cover any of the services, check YES and complete items 9, 9a and 9d. Only one box can be marked. |
12. PATIENTS OR AUTHORIZED PERSON'S SIGNATURE | Enter "Signature on File," "SOF" or legal signature, |
13. INSURED'S OR AUTHORIZED PERSON'S SIGNATURE | Enter "Signature on File," "SOF" or legal signature. |
14. DATE OF CURRENT: ILLNESS (First symptom) OR INJURY (Accident) OR PREGNANCY (LMP) | Required when services furnished are related to an accident, whether the accident is recent or in the past. Date of the accident. Enter the qualifier to the right of the vertical dotted line. Use Qualifier 431 Onset of Current Symptoms or Illness; 484 Last Menstrual Period- |
15. OTHER DATE | Enter another date related to the beneficiary's condition or treatment, Enter the qualifier between the left-hand set of vertical, dotted lines. The "Other Date" identifies additional date information about the beneficiary's condition or treatment. Use qualifiers: 454 Initial Treatment 304 Latest Visit or Consultation 453 Acute Manifestation of a Chronic Condition 439 Accident 455 Last X-Ray 471 Prescription 090 Report Start (Assumed Care Date) 091 Report End (Relinquished Care Date) 444 First Visit or Consultation |
16. DATES PATIENT UNABLE TO WORK IN CURRENT OCCUPATION | Not required. |
17. NAME OF REFERRING PROVIDER OR OTHER SOURCE | Referring physician's name and title. ADDT optional therapy services require primary care physician (PCP) referral. |
17a. (blank) 17b. NPI | The 9-digit Arkansas Medicaid provider ID number of the referring physician. Not required. |
18. HOSPITALIZATION DATES RELATED TO CURRENT SERVICES | When the serving/billing provider's services charged on this claim are related to a beneficiary's or participant's inpatient hospitalization, enter the individual's admission and discharge dates. Format; MM/DD/YY. |
19. ADDITIONAL CLAIM INFORMATION Code E F | For tracking purposes, ADDT providers are required to enter one of the following therapy codes: Category Individuals aged 18 years and up who are receiving therapy services through the Division of Developmental Disabilities Services. Individuals aged 18 years and up who are receiving therapy services through individual or group providers not included in any of the previous categories (A-E). |
20. OUTSIDE LAB? $ CHARGES | Not required. Not required. |
21. DIAGNOSIS OR NATURE OF ILLNESS OR INJURY | Enter the applicable ICD indicator to identify which version of ICD codes is being reported. Use "9" for ICD-9-CM Use"[LESS THAN]rforlCD-10-CM. Enter the indicator between the vertical, dotted lines in the upper right-hand portion of the field. Diagnosis code for the primary medical condition for which services are being billed. Use the appropriate International Classification of Diseases (ICD). List no more than 12 diagnosis codes. Relate lines A-L to the lines of service in 24E by the letter of the line. Use the highest level of specificity. |
22. RESUBMISSION CODE ORIGINAL REF. NO. | Reserved for future use. Any data or other information listed in this field does not/will not adjust, void or otherwise modify any previous payment or denial of a claim. Claim payment adjustments, voids and refunds must follow previously established processes in policy. |
23. PRIOR AUTHORIZATION NUMBER | The prior authorization or benefit extension control number if applicable. |
24A. DATE(S) OF SERVICE B. PLACE OF SERVICE C. EMG D. PROCEDURES, SERVICES, OR SUPPLIES CPT/HCPCS MODIFIER E. DIAGNOSIS POINTER F. $ CHARGES G. DAYS OR UNITS H. EPSDT/Family Plan 1. ID QUAL J. RENDERING PROVIDER ID# NPI | The "from" and "to" dates of service for each billed service. Format: MM/DD/YY. 1. On a single claim detail (one charge on one line), bill only for services provided within a single calendar month. 2. Providers may bill on the same claim detail for two or more sequential dates of service within the same calendar month when the provider furnished equal amounts of the service on each day of the date sequence. Two-digit national standard place of service code. See Section 262.200 for codes. Enter "Y" for "Yes" or leave blank if "No." EMG identifies if the service was an emergency. Enter the correct CPT or HCPCS procedure code from Sections 262.100 through 262.110. Enter the applicable modifier from Section 262.110. Enter the diagnosis code reference letter (pointer) as shown in Item Number 21 to relate to the date of service and the procedures performed to the primary diagnosis, When multiple services are performed, the primary reference letter for each service should be listed first, other applicable services should follow, The reference letter(s) should be A-L or multiple tetters as applicable, The "Diagnosis Pointer" is the line letter from Item Number 21 that relates to the reason the service(s) was performed The full charge for the service(s) totaled in the detail. This charge must be the usual charge to any client, patient, or other beneficiary of the provider's services. The units (in whole numbers) of service(s) provided during the period indicated in Field 24A of the detail, Enter E if the services resulted from a Child Health Services (EPSDT) screening/referral. Not required The 9-digit Arkansas Medicaid provider ID number of the individual who furnished the services billed for in the detail Not required. |
25. FEDERAL TAX I.D. NUMBER | Not required This information is carried in the provider's Medicaid file. If it changes, please contact Provider Enrollment. |
26. PATIENT'S ACCOUNT N O. | Optional entry that may be used for accounting purposes; use up to 16 numeric or alphabetic characters. This number appears on the Remittance Advice as "MRN." |
27. ACCEPT ASSIGNMENT? | Not required. Assignment is automatically accepted by the provider when billing Medicaid. |
28. TOTAL CHARGE | Total of Column 24F-the sum all charges on the claim. |
29. AMOUNT PAID | Enter the total of payments previously received on this claim. Do not include amounts previously paid by Medicaid. *Do not include in this total the automatically deducted Medicaid or co-payments. |
30. RESERVED | Reserved for NUCC use. |
31. SIGNATURE OF PHYSICIAN OR SUPPLIER INCLUDING DEGREES OR CREDENTIALS | The provider or designated authorized individual must sign and date the claim certifying that the services were personally rendered by the provider or under the provider's direction. "Provider's signature" is defined as the provider's actual signature, a rubber stamp of the provider's signature, an automated signature, a typewritten signature, or the signature of an individual authorized by the provider rendering the service. The name of a clinic or group is not acceptable. |
32. SERVICE FACILITY LOCATION INFORMATION a. (blank) b, (blank) | If other than home or office, enter the name and street, city, state, and zip code of the facility where services were performed. Not required. Not required. |
33. BILLING PROVIDER INFO & PH # a. (blank) b. (blank) | Billing provider's name and complete address. Telephone number is requested but not required. Not required. Enter the 9-digit Arkansas Medicaid provider ID number of the billing provider. |
242.400Special Billing Procedure Special billing procedure are not applicable to this program
100GOVERNING BOARD/ORGANIZATION / LEADERSHIPGuiding Principles:The Governing Board/organization/Leadership is that body of people who have been chosen by the corporation and vested with legal authority to be responsible for directing the business and affairs of the corporation. The responsibilities assured by each Board/organization member by their acceptance of membership are to provide effective and ethical governance leadership on behalf of its owners'/stakeholders' interest to ensure that the organization focuses on its purpose and outcomes for persons served, resulting in the organization's long-term success and stability.
The mission statement of the organization is-based on the Board/organization's philosophical motivations, the services provided, and values of the members. The mission statement should identify the population to be served and the services to be provided. This description shall be nondiscriminatory by reason of sex, age, disability, creed, marital status, ethnic, or national membership.
NOTE: See Arkansas Code Ann. §§ 20-48-201 - 20-48-211 for examples of Board/organization responsibilities.
NOTE: All information regarding your organization shall be readily available to staff, consumers,
referral and funding sources, and the interested public pursuant to the Freedom of Infonnation Act.
101 The organization shall be legally incorporated under the appropriate federal, state or local statues as defined by its official Articles of Incorporation and registered to do business in the State of Arkansas. A. The governing body should periodically rev ievv the appropriateness of its governing documents. (Ark. Code Ann. 4}t} 20-48-201 - 20-48-211 ). This shall include the organizations mission statement as filed with the Secretary of State, and the Articles of Incorporation.B. Any changes in the Articles of Incorporation must be filed with the Secretary of State. This includes name changes, amendments, or any reconstitution of the Governing Board'organization. The organization shall provide copies of any changes to DDS upon filing.102 Bylaws shall be established which govern the internal affairs of the organization and will address each of the following areas as applicable: A. Composition of Board 1. This shall include the number of Board members and the eligibility criteria (i.e. citizenship and residency).2. Selection of Board members a. Twenty percent (20°o) consumer and advocate representation on the Board is required. (Note; defined as a consumer, immediate family member or guardian of a consumer receiving services or has received services at the organization or person in a qualified position that advocates on behalf of the population sened)B. Term of membership: 1. Number of years as dictated by the organization's Articles of Incorporation. Note: It is recommended that membership on the governing body be rotated periodically.C. Replacement/removal of directors:1. Refers to written criteria for Board membership Shall include any contingency to include but not be limited to resignation of Board organization members and removal for non-attendance or other reasons.D. Election of officers and directors:1. Describe the election processE. Duties and responsibilities of Board officers, are described in writing 1. Must document each position's purpose, structure, responsibilities, authority, if any, and the relationship of the advisory committee of Board members to other entities involved with the organization.F. Appointment of committees, if applicable; 1. Duties and functions of standing committees are described in writing, if applicable.G. Meetings of the Board organization and its committees. All meetings shall be planned, organized, and conducted in accordance with the organization's by-laws, policies, procedures, applicable statutes, or other appropriate regulations. In no event shall the full Board organization meet less than four times per year. Note: The Board/organization and its committees should meet with a frequency sufficient to discharge their responsibilities effectively.
H. The Board/organization shall adopt written procedures to guide the conduct of its meetings i.e. Parliamentary Procedure, Robert's Rules of Order, etc.); I. The Board, organization shall maintain minutes of all actions taken by the Board organization for review by DDS. Minutes shall accurately document all members present and any action taken at the committee meetings to include any committee recommendations to the Board organization.
1. Written minutes of previous Board organization meetings should be made available by posting the adopted minutes in a location convenient to the staff and individuals served, and made available to members of the public upon request, as required under the Freedom of Information Act.103 The Board organization shall establish a procedural statement addressing nepotism as it relates to Board organization and staff positions. 103.1 The Board shall establish a procedural statement addressing conflict of interest Note: The intent of the standard does not rule out a business relationship, hut does call for the governing body to decide in advance what relationships are in the best interest of the organization.
A. Paid employees may not serve as Board members. (Note: This pots no I include individuals receiving services.) Note: Paid employees serving on the Hoard as of 11 01 07 max continue to serve for the remainder of their current term at w Inch lime they must rotate off the Hoard.
B. Directors of organizations may serve as non-voting ex officio Board members.104 Board organization meetings and public meetings as defined by Ark. Code Ann. §§ 25-19-106 shall be conducted at a time and place which make the meetings accessible to the public. Specifically, except as otherwise specifically provided by law, all meetings, formal or informal, special or regular, of the governing bodies of all municipalities, counties, townships, and school districts and all boards, bureaus, commissions, or organizations of the State of Arkansas, except grand juries, supported wholly or in part by public funds or expending public funds, shall be public meetings. A. Board/organization meetings and Executive sessions shall be announced to be in compliance with Ark. Code Ann. §§ 25-19-101 - 25-19-107 "Freedom of Information Act"B. All local media are to be notified one week in advance and a notice posted in a prominent place by the organization. Called meetings shall be announced to the local media and others who have requested notification at least two hours in advance of meeting. Documentation of Notification may include newspaper clippings, copy of item posted on bulletin Board, organization, radio contact forms, etc.D. If the meetings arc held each month at the same time and location, one notification and posting shall be sufficient.105 The Board/organization of Directors shall adopt a mission statement to guide its activities and to establish goals for the organization. The plan shall show evidence of participation by stakeholders (evidence of open meeting, letters of input, survey, questionnaire, etc.).105.1 The Board organization of Directors shall review the mission statement annually and shall make changes as necessary to ensure the overall goals and objectives of the organization are reflected in its mission.106 The Board organization maintains a plan which shall identify annual and long range goals; the plan should address community needs and target populations and should be reviewed and updated annually. A. Each Board organization will develop and implement a long-range plan of action for that organization. Examples include, but are not limited to starting a new component, accessing individualized services in the community, etc.B. Development and implementation of the plan shall include stakeholder input. The organization shall maintain evidence of this input (i.e., letters of input, minutes of open meetings, questionnaires, surveys, etc.)C. The plan shall be reviewed annually and updated as needed. The Board organization shall approve the initiation, expansion, or modification of the organization's program based on the needs of the community and the capability of the organization to have an effect upon those needs within its established goals and objectives. Note: The Board organization of Directors, at its discretion, may assign this responsibility to staff.
107 The Board/organization shall demonstrate corporate social responsibility while maintaining overall accountability for the administration and direction of the organization, and shall delegate authority and responsibility to executive leadership as deemed appropriate by the organization. A. The organization shall identify: 1. Its leadership structure.2. The roles and responsibilities of each level of leadership.B. The identified leadership shall guide the following: 1. Establishment of the mission and direction of the organization.2. Promotion of value achievement of outcomes in the programs and services offered.3. Balancing the expectations of both the persons served and other stakeholders, as defined by the organization's policies.5. Compliance with insurance and risk management requirements.6. Ongoing performance improvement.7. Development and implementation of corporate responsibilities.8. Compliance with all legal and regulatory requirements.C. The organization shall respond to the diversity of its stakeholders with respect to: 108 The Board organization shall create a mechanism for monitoring the decisions and operations of the organization's programs which includes provisions for the periodic review and evaluation of its program in relation to the program goals. Documentation of the review must be maintained on file for review. Documentation may include but not be limited to Board'organization minutes, reports, etc. Guiding Principle: An organized training program for Board/organization Members prepares them for their responsibilities and assures that they are kept up-to-date on issues concerning services offered to individuals with a developmental disability
109 The Board shall maintain a general plan for Board organization training and will ensure that all items listed as required topics are covered in the required three-hour training. A. Training shall be provided for all Board, organization members. Where the Board, because of its size, lacks sufficient resources to conduct a training program, it will make arrangements with another Board, organization, agency, appropriate community resource, or training organization lo provide such training. 109.1New Board Members must participate in a minimum of three hours of training, A. The following topics shall be required during the first year of service 1. Functions and Responsibilities of the Board2. Composition and Size of the Board3. Legal Responsibilities4. Funding Sources and Responsibilities,5. Equal Employment Opportunity Affirmative Action,7. Ark. Code Ann. §§ 25-19-101 - 25-19-107 "Freedom of Information Act of 1967"8. U. S. C. § 12101 et. seq. "Title 42 THE PUBLIC HEALTH AND WELFARE-CHAPTER 126- EQUAL OPPORTUNITY FOR INDIVIDUALS WITH DISABILITIES-!} 12101. Findings and purpose"9. DDS Service Policy 3004-1 Maltreatment Prevention, Reporting and Investigation;10. DHS Policy 1090, Incident Reporting.11. DDS Administrative Policy 107712. Chemical Right to Know13. The Health Insurance Portability and Accountability Act (HIPAA) Note: Possible Tra i king resol rces include aspen Pub actnews, which has ma teria ls
ONBOARD/ORGANIZATtO\ ASD ADMINISTRATOR TRAINING. (HUH.ASPENPUBLISHERS.COM)
Resources or additional information should be obtained from DDS Licensure.
B. All new Board members as they begin service shall participate in training. Board members may disseminate training information to new Board members if they are unable to attend formal training sessions. Documentation of the information provided, date provided and the board membcr(s) involved must be maintained for review by DDS. (Note: Training may be documented in Board minutes or by Certificates of Attendance.)109.2 All Board members shall complete a minimum of three hours annual training. Topics may be selected by the Board of Directors and must be germane to the annual plan and services provided. Training should be documented in Board minutes, by Certificates of Attendance or sign in sheets from approved training.110 Board members shall visit service components of the organization during operating hours yearly. A. All components of the organization must be observ ed annually. If on-site observations to each physical location are not feasible, at least I physical site from each program component must be observed during the calendar year. The sites must be rotated yearly. Committees or individual Board Members may be appointed to visit specific components and report back to the other Board members on observations. Documentation of reports in Board minutes shall be accepted as verification,111 The Board organization shall establish and approve policies and procedures which define Eligibility criteria, Readmission criteria, and transition discharge exit criteria
112 The Board, organization shall establish policy regarding financial oversight of the organization that addresses the following: A. The organization's financial planning and management activities reflect strategic planning designed to meet: 1. Established outcomes for the persons served.2. Organizational performance objectives. B.Budgets are prepared that: 1. Include: a. Reasonable projections of revenues and expenditures.b. Input from various stakeholders, as required.c. Comparison to historical performance.2. Are disseminated to: a. Appropriate personnel.b. Other stakeholders, as appropriate.C. Actual financial results are:2. Reported to: a. Appropriate personnel.b. Persons served, as appropriate.c. Other stakeholders, as required.3. Reviewed at least quarterly.D. The organization identifies and reviews, at a minimum: 1. Revenues and expenses.2. Internal and external; c. Financial opportunities.e. Management information.3. Financial solvency, with the development and implementation of remediation plans, if appropriate.113 For-profit organizations or organizations uho receiv e less than SI (),()()() in compensation for services under this program shall submit a compilation report (hat includes a balance sheet and statement of revenue and expense to DDS at the close of each financial period, Note: Sections 102 & 104 do not apply to organizations that are not governed by a Board of Directors
200 PERSONNEL PROCEDURES & RECORDS 201 The organization shall maintain written personnel procedures that are approved by the Board and are reviewed annually and which conform to state and federal laws, rules and regulations. NOTE: DDS SHALL NOT BECOME DIRECTLY IMOLl ED IN PERSONNEL ISSUES UNLESS IT DIRECTLY IMPACTS CONSUMER CARE AXD/OR SAFETY.
201.1 Personnel procedures shall be clearly stated and available in written form to employees as required by 42 U.S.C. § 2000a - 2000 h-6 "Title VI of the Civil Rights Act of 1964" and U.S.C. § 1201 et. Seq. Americans with Disabilities Act. These include but are not limited to: A. Hiring and promotional procedures which are nondiscriminatory by reason of sex, age, disability, creed, marital status, ethnic, or national membershipB. A procedure for discipline, suspension and or dismissal of staff which includes opportunities for appealC. An appeals procedure allowing for objective review of concerns and complaints201.2 One copy of the organization's Personnel procedures must be available in the personnel or administrator's office. This copy must be readily accessible to each employee.201.3 The organization shall develop and implement steps to voice grievances within the organization. All grievances are subject to review by the Governing Board and Court of Law ( 29 U.S.C. §§ 706(8), 794 - 794(b), the "Rehabilitation Act of 1973 Section 504; 20 U.S.C. § 1400. et. Seq. Section 615 "The Individual Disabilities Education Act". A. All steps in the Grievance Procedure should be time4x[GREATER THAN]und and documented, including initial tiling of grievance.201.4 The organization shall develop and implement policies regarding whether pre-employment and random drug testing will be required. If the organization chooses to do drug testing they must establish guidelines for actions to be taken when the drug test results are obtained, whether positive or negative. Note: The organization may contact Arkansas Transit Association for further information on drug testing
202 Prior to employment, a completed job application must be submitted which includes the following documents. A. The organization shall obtain and verify PRIOR to employment and maintain documentation of the following: 1. The ereden I ia I s req ui red2. That required credentials remain current3. The applicant has completed a statement related to criminal convictions4. A criminal background check has been initiated. Refer to DDS Policy 1087.5. Declaration of truth of statement on job application.6. A release to complete reference checks is signed and reference checks have been completed7. Results of pre-employment drug screen, if required by organization. NOTE:THE ITEMS IN 202.15 A\D 202A.6 WILL XOTBE RA TED FOR EMPLOYEES HIRED PRIOR TO JULY I, I986.
B. The organization shall obtain and verify within 30 days of employment and maintain documentation of the following: 1. Adult Maltreatment Central Registry Ark. Code Ann. §§ 5-28-201 has been completed and the response is filed, or a second request submitted2. Arkansas Child Maltreatment Central Registry Ark. Code Ann. §§ 12-12-501 - 12-12-515 has been completed and the response is filed, or a second request submitted. This check will provide documentation that prospective employee's name do not appear on the statewide Central Registry. a. The organization should adopt policy requiring subsequent criminal checks and registry checks. The organizations that provide licensed daycare services must adhere to Child Care Licensing regulations regarding Criminal background checks and central registry cheeks. Note: Staff holding professional licenses may be used in lieu of criminal
background and adult and child maltreatment checks.
3. TB skin test a. Renewed yearly for ALL STAFF.4. Hepatitis B series or signed declination5. The results of criminal background check of the will be on file.6. Employment reference verification and signed release a. On file within thirty (30) days of hire dateC. The organization shall obtain and verily information in 202 A and B in response to information received (i.e., a complaint is received that a person's license has lapsed or a person has been convicted of a crime since they were hired). 203 The agency shall ensure sub-contractor's services meet all applicable standards and will assess performance on a regular basis. A. The organization shall ensure thai sub-contractors providing direct care services are in compliance with DDS policies and must have verification and documentation of all applicable items listed in 202A. Note:Staff holding professional licenses may he used in lieu of criminal background and adult and child maltreatment checks.
B. The organization shall demonstrate: 1. Reviews of all contract personnel utilized by the organization that: a. Assess performance of their contracts b.Ensure all applicable policies and procedures of the organization are followed c.Ensure they conform to DDS standards applicable to the services provided 204 The organization shall develop, implement and monitor policies and procedures for staff recruitment and retention so that sufficient staff is maintained to ensure the health and safety of the individuals served, according to their plans of care. A. The organization must ensure there are an adequate number of personnel to: 1. Meet the established outcomes of the persons served.2. Ensure the safety of persons served.3. Deal with unplanned absences of personnel.4. Meet the performance expectations of the organization.B. The organization shall demonstrate: 3. Identification of any trends in personnel turnover.205 The organization shall develop and implement procedures governing access to staff members' personnel file. A. An access sheet shall be kept in front of the file to be signed and dated by those who are examining contents, with stated reasons for examination.B. The policy shall clearly state who, when, and what is available concerning access to personnel files and be in compliance with the Federal Privacy Act and Freedom of Information Act. At no time shall the policy allow access that violates the provisions of the Health Insurance Portability and Accountability Act (H1PAA).206 The organization shall develop written job descriptions which describe the duties, responsibilities, and qualifications of each staff position. A. The organization shall; 1. Identify the skills and characteristics needed by personnel to: a. Assist the persons served in the accomplishment of their established outcomes.b. Support the organization in the accomplishment of its mission and goals.2. Assess the current knowledge and competencies of personnel at least annually.3. Provide for the orientation and training needs of personnel.4. Provide the resources to personnel for learning and growth.5. Identify the supervisor of the position and the positions to be supervised.B. Performance management shall include: 1. Job descriptions that are rev iewed and, or updated annually.3. Job posting guidelines.4. Performance evaluations for all personnel directly employed by the organization shall be: a. Based on measurable objectives that tie back to specific duties as listed in the Job Description.b. Evident in personnel files.c. Conducted in collaborntion with the direct supervisor with evidence of input from the personnel being evaluated d. Used to: 1. Assess performance related to objectives established in the last evaluation period.2. Establish measurable performance objectives for the next year.207 The organization shall establish employment policies practices for students, interns, volunteers and trainees utilized by the organization who have regular, routine contact with consumers. A. The organization shall define who has and what constitutes regular, routine contact with consumers.B. If students, interns, volunteers or trainees are used by the organization, the following shall be in place: 1. A signed agreement. a. If professional services are provided, standards or qualifications applied to comparable positions must be met.2. Identification of: b. Scope of responsibility.3. Orientation and training.4. Assessment of performance.5. Policies and written procedures for dismissal.6. Confidentiality policies.7. Background checks, when required. 300 STAFF TRAINING Guiding Principle: Staff Training is an organized program which prepares new employees to perform their assigned duties competently and maintains and improves the competencies of all employees. Staff Training for the organization shall provide an on-going mechanism for the evaluation of the impact of the program on services provided to individuals with developmental disabilities. This should include service outcomes to individuals, meeting of the organization objectives and overall mission, compliance with regulatory and professional standards and positive changes in staff performance and attitudes. The needs of individuals with developmental disabilities require the efforts of competent personnel who continually seek to expand knowledge in their fields.
300.1 The organization shall establish a policy designating one or more employees to be responsible for coordinating in-service staff training. A. The employee responsible for staff training should have broad knowledge of care and service needs of persons with developmental disabilities, and possess the necessary skills to organize and implement an in-service training program as evidenced in resume.301 The organization shall establish a written training plan. This plan must show how the training will be provided and the areas covered. If training occurs during regularly scheduled service hours, documentation must be present that individual staff ratios were maintained.301.1 ALL Personnel shall receive initial and annual competency-based training to include, but not limited to: A. Health and safety practices. 1. First Aid (review yearly, renew as required by American Heart Association, Red Cross, or Medic First Aid, applicable for ALL direct service personnel) a.There is immediate access to: (2) First aid equipment and supplies.(3) Emergency information on the:b. Infection Control Plan 1. The organization shall implement an infection control plan that includes: (a).Training regarding the prevention and control of infections and communicable diseases for: (1).Persons served, when applicable. (b).The appropriate use of standard or universal precautions by all personnel. (c).P roced ures that spec ify thai cm pi oyces with in feci ious diseases shall be prohibited from contact with individuals until a physician's release has been provided to the organization director.B. Identification of unsafe environmental factors.1. Issues Regarding Prevention of Acquired Immunodeficiency Syndrome +(AIDS) , Hepatitis B (HIV) and other Bloodbomc Pathogens C. Emergency procedures and Evacuation Procedures 1. Emergency and Disaster Preparedness2. Fire and Tornado Drills, Violence in the Workplace, Bomb Threats, EarthquakeD. General Information 1. Overview of Department of Human Sen ices2. Overview of Developmental Disabilities Services3. Philosophy, Goals, Programs, Practices, Policies, and Procedures of Local Organization4. HIPP A policies and procedures5. Orientation to history of Developmental Disabilities6. Current Issues Affecting Individuals with Developmental Disabilities7. Introduction to Principles of Normalization8. Procedures for Incident Reporting9. Appeals Procedure for Individuals Served by the Program10. Introduction to Behavior Management11. Community Integration Training.E. Legal 1. Overview of Federal and State Laws related to serving individuals with a developmental disability (NOTE: Laws may change every 2 years)2. Legal Rights of Individuals with Developmental Disabilities3. Application of Federal Civil Rights Laws to Persons with AIDS or HIV related condition (or those who may be perceived to have AIDS or HIV related conditions).4. Ark. Code Ann. $ 56-41-2016-41-222 -The Children With Disabilities Act of 19735. Ark. Code Ann. §§ 20-48-201 - 20-48-211: -Arkansas Mental Retardation Act6. Ark. Code Ann. §§ 25-19-10125-19-107 -Freedom of Information Act7. Ark. Code Ann. §§ 28-65-101 - 28-65-109; -Guardians Generally8. Ark. Code Ann, §§ 5-28-101 - 5-28-109; -Abuse of Adults9. Ark. Code Ann. §§ 12-12-501 - 12-12-515; -Arkansas Child Maltreatment Act10. Ark. Code Ann. §§ 25-2-104, 25-2-105, 25-2-107. Type I, Type 2 and Type 4 Transfers11. Ark. Code Ann. §§ 25-10-10225-10-116; Department of Health and Human Services General Provisions12. Ark. Code Ann. §§ 20-78-215 - Child sexual abuse - Federal funds13. U.S.C. § 12101 et. scq -Americans with Disabilities Act of 1990 P. L. 101-336 14.20 U.S.C. § 1400 et. scq (Part B and Part C - P. L. 94-142 Individuals with Disability Education (IDEA) P.L. 99-457 Part C15.42U.S.C. § 2000a2000 h-6- Title VI of the Civil Rights Act of 196416.29 U.S.C. §§ 706(8) Rehabilitation Act of 1973, 794 - 794(b) Section 50417.5 U.S.C. § 552a - Federal Privacy Act18.42 U.S.C. § 6000 - Developmentally Disabled Assistance & Bill of Rights Act of 198419. P.L. 109-171, Deficit Reduction Act, and 30 U.S.C. § 3729 etseq. False Claims Act Note: Documentation of prior training of individual staff may be used for the required topics, if this situation is addressed in the organization 's training plan.301.2. Documentation of prior training of individual staff may be used for the required topics, if this situation is addressed in the organization's training plan.301.3. Training Requirements for professional administrative staff, as defined by the agencies policies 1. Twelve (12) hours minimum completed within ninety (90) days of employment (does not include First Aid and CPR training)301.4. Training Requirements for direct care staff1. Twelve (12) hours minimum completed within (30) days of employment (does not include First Aid and CPR training)2. In addition to the training requirements specitled Section 301.1, all direct care staff must receive the following training:a. CPR (I nitial Certification, renew as required by American Heart Association, Medic First Aid, or Red Cross). 1. ALL direct care staff members, including bus and van drivers, shall be trained and certified to provide CPR, unless they arc deemed incapable of performing this task by a licensed medical professional, such as a nurse or doctor. Documentation must be maintained in the personnel file. Staff that are physically incapable of performing CPR must complete and have documentation of CPR training.b. The organization shall develop and implement and monitor policy regarding timeframe for CPR certification after hire date. (Timeframe not to exceed 90 days.)3. Medication-Implications, Side Effects, Legality of Administering medication. NOTE: In addi i ion to tiiosi ar» as addressed in these standards,
OTHER IDENTIFIED NEEDS BASED ON STAFF INPUT SHOULD BE ADDRESSED.
NOTE; SEE APPENDIX B for Training Resources
301.5. In addition to the requirements in Section 301.1 -301.4, all direct care staff shall receive annual in-service training and or continuing education as follows: A. Minimum of twelve (12) hours of training annually, including the required topics,1. Topics must be applicable to the job and are to be chosen by the organization based on identified needs. Topics may be a combination of required and job specific training. 2. Behavior management techniques programming B.Documentation of the training shall be maintained in the staffs personnel file and shall be evidenced by the signatures of the trainer and the direct care staff, the date the training was provided and the specific information covered.302 Annual in-service training and or continuing education for Managerial Staff, as defined by the agencies policies. A. Topics Chosen must be related to the job performed.B. Minimum of twelve (12) hours of training required yearly, from the following list: 1. Issues Regarding Prevention of Acquired Immunodeficiency Syndrome (AIDS), Hepatitis B (HIV) and other Blood Borne Pathogens2. Application of Federal Civil Rights Laws to persons with AIDS or HIV related Conditions (or those who may be perceived to have AIDS or HIV Related conditions)3. Management of Non-Profit Organizations4. Procedures for Preventing and Reporting Alleged Maltreatment of Children and Adults5. Effective Supervision Management Techniques6. Selection and Interviewing7. Fair Employment Principles8. Performance Evaluation9. Techniques for Working with the Board10. Overview of Federal and State Laws Related to Serv ing Individuals with a Developmental Disability (up-dated every two (2) years) 11.Federal and State Law s: a. Ark. Code Ann. §§ 6-41-201 - 6-41-222 -The Children With Disabilities Act of 1973b. Ark. Code Ann. §§ 20-48-201 - 20-48-211 -Arkansas Mental Retardation Actc. Ark. Code Ann. §§ 25-19-101 25-19-107 -Freedom of Information Actd. Ark. Code Ann. §§ 28-65-101 - 28-65-109; --Guardians Generallye. Ark. Code Ann. §§ 5-28-101 - 5-28-109; -Abuse of Adultsf. Ark. Code Ann. §§ 12-12-50112-12-515; -Arkansas Child Maltreatment Actg. Ark. Code Ann. §§ 25-2-104, 25-2-105. 25-2-107, Type 1, Type 2 and Type 4 Transfersh. Ark. Code Ann. §§ 25-10-102 - 25-10-116, Department of Health and Human Services General Provisions i. Ark. Code Ann. §§ 20-78-215 - Child sexual abuse - Federal funds j. U.S.C. § 12101 et. seq. -Americans with Disabilities Act of 1990 P. L.k.20 U.S.C. § 1400 et. seq. (Part B and Part C - P. L. 94-142 Individuals 101-336with Disability Fdueation (IDEA) PL. 99-457 Part C I. 42US.C. §2000a 2000 h-6- I itlc VI of the Civil Rights Act of 1964m.29 U.S.C. §§ 706(S) Rehabilitation Act of 1973, 794 794(b) Section 504n.5 U.S.C. § 552a-- Federal Privacy Act o.42 U.S.C. § 6000- 6083 - Developmentally Disabled Assistance & Bill of Rights Act of 1984 C. Managerial Staff, as defined by the agencies policies, who have been with the agency for 2 or more years may select from the above list or choose from continuing education courses. Note: SEE APPENDIX B for Training Resources
303 All employees who provide transportation services shall have the following training scheduled within thirty (30) days of employment and completed within seventy-five (75) days of employment. This training shall be in addition to the required new employee training listed in Section 301 A. A course of instruction in consumer assistance and transfer techniques, lift operation and how to properly secure a wheelchair, if applicable, prior to transporting consumers; andB. The provider must assure and document that each driver obtains the following: 1. A certificate of completion of an introductory defensive driving course;2. A certification of completion of training addressing the transport of older persons and people with disabilities, and a refresher course every three years thereafter, both of which must include: a. Sensitivity to aging training;b. An overview of diseases and functional factors commonly affecting older adults;c. Environmental considerations affecting passengers;d. instruction in consumer assistance and transfer techniques;e. Training on the management of wheelchairs, and how to properly secure a wheelchair;f. The inspection and operation of wheelchair lifts and other assistive equipment; and,D.Drivers are required to complete refresher courses every three years after the date the certificate(s) of completion was received. Note: For all transportation workers employed prior to i I 01 07, documentation of the required training must be on file no later than 11 01 OS,
304 Providers must assure: A. Maintenance of a safety checklist completed prior to transporting consumer(s) and or travel attendants. Checklist items shall include, but not be limited to, fire extinguisher; first aid kit,B. Maintenance of service logs or trip sheets that include the date of service the consumer's name, the pick-up point and destination point for each trip, total mileage per trip, and the driver's signature.C. Assistance in transfer of the consumer, as necessary, safely from the consumer's door to the vehicle and from the vehicle to the entrance of the destination point. The provider must perform the same transfer assist service when transporting the consumer back to the consumer's residence. 400Individual/Parent/Guardian RightsGuiding Principle: The organization shall implement a system of rights that nurtures and protects the dignity and respect of the persons served. The organization shall protect and promote the rights of the persons served. This commitment shall guide the delivery of services and ongoing interactions with the persons served.
401 The organization shall implement policies promoting the following rights of the persons served and ensures all information is transmitted to the person served and or their parent or guardian in a manner and fashion that is clear and understandable: A. Being free from physical or psychological abuse or neglect, retaliation, humiliation, and from Financial exploitation.B. Having control over their own financial resources.C. Being able to receive, purchase, have and use their own personal property.D. Actively and meaningfully making decisions affecting their life.E. Access to information pertinent to the person served in sufficient time to facilitate his or her decision making.G. Being able to associate and communicate publicly or privately with any person or group of people of the individual's choice.H. Being able to practice the religion of their choice.I. Being free from the inappropriate use of a physical or chemical restraint, medication, or isolation as punishment, for the convenience of the provider or agent, in conflict with a physician's order or as a substitute for treatment, except when a physical restraint is in furtherance of the health and safety of the individual. J.Not being required to work without compensation, except when the individual is residing and being provided services outside of the home of a member of the individual's family, and then only for the purposes of the upkeep of their own living space and of common living area and grounds that the individual shares with others. K. Being treated with dignity and respect.L. Receiving due process.M. Having access to their own records, including information about how their funds arc accessed and utilized and what services were billed for on the individual's behalf.N. Informed consent or refusal or expression of choice regarding: 2. Release of information.4. Composition of the service delivery team.5. Involvement in research projects, if applicable. O. Access or referral to legal entities for appropriate representation.P. Access to self-help and advocacy support services.Q. Adherence to research guidelines and ethics when persons served are involved, if applicable. R. Investigation and resolution of alleged infringement of rights. 1. The agency maintains documentation of all investigations of all alleged violations of individual's rights and actions taken to intervene in such situations. The organization ensures that the individual has been notified of their right to appeal according to DDS Policy 1076.R. Rights and responsibilities of citizenshipS. Other legal and constitutional rights 402 Records of persons served A. The organization shall maintain complete records and treat all information related to persons served as confidential.B. The organization shall create policy for the sharing of confidential billing, utilization, clinical and other administrative and service-related information, and the operation of any Intemet-based services that may exist. 1. Information that is used for reporting or billing shall be shared according to confidentiality guidelines that recognize applicable regulatory requirements such as the Health Insurance Portability and Accountability Act (H1PAA).C. The organization shall comply with its own service delivery design for the development of the record. Electronic records are acceptable. Electronic records must meet the following: 1. Format must meet DHS Office of Systems and Technology standards and be acceptable by the Department.2. Files must be uniformly organized and easily accessible.D. The location of the case record, and the information contained therein, shall be controlled from a central location as defined by the agency, shall be stored under lock and with protection against fire, water, and other hazards in an accessible location at each site. The organization shall establish and implement policies and procedures to ensure direct care staff have adequate access to the individual's current plan of care and other pertinent information necessary to ensure the individual's health and safety (i.e., name and telephone number of physician, emergency contact information, insurance information, etc.). If services are not provided at the central location, at a minimum the following information must be maintained at the service delivery site:B. Face Sheet to include emergency contact information and pertinent health informationC. Signed consent for emergency treatmentD. A copy of the consumer's current program planE. Copies of current progress reportsF. Documentation of serv ice prov jsion to include date, time in and time out, summary of activities, and signature of implementor for the period of the current program planE. Records maintained on computer shall be backed up at a minimum weekly and the duplicate copy shall be stored under lock and with protection against fire, water, and other hazards.F. A list of the order of the file information shall either be present in each individual case file or provided to DDS Licensure staff upon request. The documents in active individual case records should be organized in a systematic fashion. An indexing and filing system shall be maintained for all case records.G. Each organization shall have written procedures to cover destruction of records. Procedures must comply with all state and federal regulationsH. Access sheets shall be located in the front of the file to maintain confidentiality according to 5 U.S.C. § 552a. If there is a signed release for a list of authorized persons to review the file, only those not listed will need to sign the access sheet with date, title, reason for reviewing, and signature. If there is not a signed release for authorized persons to review, all persons must sign the access sheet whenever the file is reviewed or any material is placed in the file.402.1 DDS staff shall have access upon demand to all individual case records as designated in Ark. Code Ann. §§ 20-48-201 - 20-48-211, DDS Policy 1090, Licensing Policy for Center-Based Community Services.402.2 The organization shall ensure confidentiality of all case records is maintained. Access to case records shall be limited to Individual Parent Guardian, professional staff providing direct services to the person served, plus such other individuals as may be authorized administratively or by the consumer. All authorizations either those listed above or others shall be in writing. A.. Access to individual files shall be limited to only those staff members who have a need to know information contained in the records of persons served.B. Individual service records shall be maintained according to provisions of the Privacy Act:C. Access to computer records shall be limited to those authorized to view recordsD. The organization shall ensure the right of all persons served to access their own records.E. The organization shall ensure that all persons served know how to access their records and the organization ensures that appropriate equipment is available.F. An organization shall not prohibit the persons served from having access to their own records, unless a specific state law indicates otherwise. It is recognized that the organization must comply with HIPAA regulations as it relates to specific information that cannot be disclosed to persons served without authorization (i.e., psychotherapy notes).402.2 Adult individuals who are legally competent shall have the right to decide whether their family will be involved in planning and implementing the individual service plan. A signed release or document shall be present in individual case record giving permission for family to be involved.402.3 The Individual /Parent /Guardian shall be informed of their rights. The organization shall maintain documentation in the individual's file that the following information has been provided in writing: The information listed in 402.3 A-l mi si hi: provided upon admission and annually TIIKRI: AFTER. A. All possible service options, including those not presently provided by the program.B. A copy of the rules of conduct and mission statement of the organization.C. Current list of Board members of the community program.D. Summary of funding sources.E. Copy of the appeal procedure for decisions made by the organization.F. Solicitation Guidelines **See Solicitation under DefinitionsG. A11 ex terna I ad vocacy services.H. Right to appeal any service decision to DDS, under DDS Policy 1076 I.Name and phone number of the DDS Service Specialist for that area 403 Grievances and Appeals Guiding Principle: The organization identifies clear protocols related to formal complaints, including grievances and appeals. An organization may have separate policies and procedures for grievances and appeals, or may include these in a common policy and procedure covering complaints, grievances, and appeals. A review of formal complaints, grievances, and appeals gives the organization valuable information to facilitate change that results in better customer service and results for the persons served.
A. The organization shall identify clear protocols related to formal complaints, including grievances and appeals.B. The organization shall: 1. Implement a policy by which persons served may formally complain to the organization.2. Implement a procedure concerning fonna! complaints that:b. Specifies: 1. That the action will not result in retaliation or barriers to services.2. How efforts will be made to resolve the complaint.3. Levels of review, which includes availability of external review.4. Time frames that are adequate for prompt consideration and that result in timely decisions for the person served.5. Procedures for written notification regarding the actions to be taken to address the complaint.6. The rights and responsibilities of each party.7. The availability of advocates or other assistance.3. Make complaint procedures and, if applicable, forms:a. Readily available to the persons served.b. Understandable to the persons served and in compliance with 29 U. S. C. §§ 706(8), 794794(b).C. These procedures shall be explained to personnel and persons served in a format that is easily understandable and meets their needs. This explanation may include, but not limited to a video or audiotape, a handbook, interpreters, etc. 403.1 The organization shall annually review all formal complaints filed. A. A written review of formal complaints: 1. Detenu ine: b. Areas needing performance improvement.c. Action plan or changes to be made to improve pcrfomiance and to reduce complaints403.2 The organization shall document a rev iew of any action plan or changes made to determine if the plan'changes were effective in reducing complaints and shall make adjustments to the plan as deemed necessary to ensure quality services.404 Health Related Issues Guiding Principle: A successful health and safety program goes beyond compliance with regulatory requirements and strives to manage risk and to protect the health and safety of persons served, employees, and visitors. A successful health and safety program addresses both minimizing potential hazards and compliance activities.
A. The organization shall implement policies/procedures to ensure the rights of individuals who have or who are perceived as having Acquired Immunodeficiency Syndrome (AIDS) or Human Immune Virus (HIV) related condition (or those who may be perceived as having AIDS or AIDS related conditions including Hepatitis B are not discriminated against in accordance with 29 U.S.C. §§ 706(8), 794 - 794(b); U.S.C. § 12101 et. seq. A copy of the policies/procedures shall be provided to each Individual'Parent/Guardian(s).B. The organization shall implement policies'procedures concerning any person admitted for services or anyone proposed for admission to ensure confidentiality shall be maintained for all information related to HIV testing, positive HIV infection, any HIV associated condition, AIDS or Hepatitis B.C. Each organization will protect the confidentiality of records or computer data that is maintained which relates to HIV, AIDS or Hepatitis B.405 Incident / Accident Reporting A. The organization shall report the following incidents to the DDS Licensing Unit in accordance with DHS Policy 1090. This report shall contain: date, accident/injury, time, location, persons involved, action taken, follow-up, signature of person writing the report. The following are reportable incidents: 1. Use of seclusion or restraint.2. Maltreatment or abuse as defined in statutes (See Ark. Code Ann. §§ 12-12-501 - 12-12-515 (503); Ark. Code Ann. §§ 5-28-101 - 5- 28-109 (102))3. Incidents involving injury: a. Accident/injury reports shall be completed for each accident/injury that requires the attention of an EMT, Paramedic or Physician. 1. Accident is defined as an event occurring by chance or arising from unknown causes.2. Injury is defined as an act that damages or hurts and results in outside medical attention.3. A copy of the report, redacted as required by the Freedom of Information Act must be sent to parent guardian of all children (0-18). and to guardian of adults regardless of severity of injury.4. Other health-related conditions resulting in Emergency treatment or hospitalization,5. Violence or aggression6. Sentinel events (i.e., an unexpected occurrence involving death or serious physical or psychological injury or the risk thereof)7. Elopement and. or wandering defined as anytime the location of a person cannot be determined within 2 hours9. Biohazardous accidents10. Use or possession of illicit substances or use or possession of licit substances in an unlawful or inappropriate manner (i.e., possession of prescription drugs by a person to whom the drugs have not been prescribed and who has no legitimate interest in possession of prescription drugs, such as a parent or guardian)11. Arrests or convictions12. Suicide or attempted suicide14. Any condition or event that prevents the delivery of DHS services for more than 2 hours15. Behavioral incidents (incidents involving an individual's actions that are aggressive, disruptive and. or present a danger to the individual or to others)16. Other areas, as required NOTE:For isdii ton is 3-21 )ii irs or \ge, OESTRtrno v of iscidest
reports mist re is compua we ii itu dep trtuestof Educa tio\ .
B. The organization shall notify the parent guardian of all children (0-18) or adults who have a guardian any time an incident injury report is submitted.C. The organization shall develop and implement policies and procedures regarding follow-up of all incidents to include a time-line for action, remediation and preventative measures that do not exceed DDS established timeframes, in accordance with DHS Policy 1090.407 Behavioral ManagementA. The organization shall develop policy and procedure that demonstrates a commitment to a system that nurtures personal growth and dignity, and supports the use of positive approaches and supportsB. The organization's policy and procedure shall ensure that when behavior management approaches are used, positive behavior interventions are implemented prior to the use of restrictive procedures.C. Written behavior management policy developed by the organization shall ensure the rights of individuals.1. The policy will be incorporated by the interdisciplinary team in programming, as appropriate.2. The plan must be rev icwed quarterly or as dictated by the needs of the individual served-3. This shall include all types of behavior management used i.e., time out, token economy, etc... This cannot include procedures that are punishing, physically painful, emotionally frightening, or deprivation, or that puts the individual served at medical risk which are used to modify behaviorsD. If restrictions are placed on the rights of a person served: 1. The organization shall follow its policies and procedures.2. The organization shall obtain informed consent from the individual parent/guardian prior to implementation.3. The organization shall have methods to reinstate rights as soon as possible.4. Staff members are trained on proper implementation of all restrictions utilized by the organization.E. The organization shall assure that maltreatment or corporal punishment of individuals will not be allowed. 1. Policies and Procedure must state that corporal punishment is prohibited. a. "Corporal punishment" refers to the application of painful stimuli to the body in an attempt to terminate behavior or as a penalty for behavior.b. 20 U.S.C. $ 1400 et. scq.; Maltreatment laws, Ark. Code Ann. §§ 12-12-501 - 12-12-515; Ark. Code Ann. $$ 5-28-101 - 5-28-109.F. Individuals shall have the right to obtain and retain private property. 1. Personal possessions are regarded as the private property of the individuals and shall not be taken away unless danger to safety of the individual or to others is present.G. Emergency Basis Procedure An emergency safety situation is defined as unanticipated behavior that places the person served or others at serious threat of violence or risk of injury if no intervention occurs.
1. The organization shall establish policies procedures for the use of restraint and/or emergency intervention procedures that must be used undertaken in the event of a emergency circumstances for a consumer who has no behavior management plan in place. The policies, procedures must identify the circumstances under which emergency procedures will be used as a protective measure in a life- or safety-threatening situation only when de-escalation has failed or is not possible.2. Emergency basis procedures may not be repeated more than three (3) times within six months without the interdisciplinary team meeting to revise the individual program plan. Each incident consists of: a behavior was exhibited, a procedure was used, the individual was no longer thought to be dangerous, the procedure was discontinued. Note: The number three (3) means three (3) distinct incidents The three (3) distinct occurrences could take place in one (I) day.
500 SERVICE PROVISION STANDARDS 501 The organization shall establish written policies and procedures for intake, evaluation, and diagnosis necessary to determine the eligibility of a person to receive services shall be documented.501.1 The organization shall designate specific staff positions assigned with the responsibility for intake, evaluation, assessment, family contact, planning, updating, and alternate placement. 502 Face sheets shall be completed at intake and shall be updated as needed and at least annually as documented by date of signature of the person designated in organization's policy.502.1 Every person receiving services shall have a service record face sheet that contains the information in 502.1 A-S and will be filed in a prominent location in the front of the file.A. Full name of individualB. Address, county of residence, telephone number and email address, if applicableC. Marital status, if applicableF. Social Security numberI. Parents or guardian's name and address and relationship, if applicableJ. Name, address, telephone number and relationship of person to contact in emergency, someone other than item 11K. Health insurance benefits and policy numberN. Statement of primary secondary disabilityO. Physician's name, address and telephone numberP. Current medications with dosage and frequency, if applicableQ. All known allergies or indicate none, if applicableR. The results of all independent, annual developmental screens conducted by the DHS third-party vendor, or authorized waiver of the developmental screen requirement.502 A case manager service coordinator evaluator shall be designated in writing and shall organize the provision of services for every individual served. The case manager service coordinator evaluator shall provide the individual or parent guardian with the name and contact information in writing. A.For every individual served, the case manager service coordinator evaluator shall: 1. Assume responsibility for intake, assessment, planning and services to the person2. Coordinate the individual program plan3. Cultivate the iiulividual's participation in the services4. Monitor and update services to assure that:a. The person is adequately oriented b. Services proceed m an orderly, purposeful, and timely mannerc. The transition and or discharge decision and arrangements for follow-up are properly made.503 Intake A. A written intake procedure shall be available upon request, shall be understandable to the individual receiving the services, shall be presented to those requesting services, and shall be followed by the organization in the evaluation of a person to determine eligibility for services.B. The organization shall implement policies and procedures for acceptance into services. Policies and procedures must: 1. Establish the criteria for the order of acceptance of any person awaiting service.2. Identify the position or entity responsible for making acceptance decisions.3. Provide opportunities for persons to learn about the organization and its services.4. When a person is found ineligible: a. The person is informed of the reasons.b. The person is given information about potential alternative services.5. Ensure that all involved are aware of their responsibilities regarding services prior to the planning and delivery of services6. Ensure signed informed consent for services are obtained and retained as required by funding sources and for legal reasons7. Ensure persons served are given information about setting their individual service goals, when applicable, planning the services to be delivered and how progress on service goals will be communicated with them.504 Information gathered prior to admission shall include the following information and shall be filed in the individual's record:A. The results of the independent, annual developmental screen conducted by the DHS third-party vendor, or the authorized waiver of the developmental screen requirement.B. Signed emergency medical release and all other necessary release forms (i.e., Publicity, field trip, fund raising, etc.). The emergency medical release form shall remain current (yearly) for the protection of the organization and the individual. 1. Competent adults must always sign their releases2. Publicity releases shall be obtained on an as-needed basis (for each occurrence)3. Field trip releases shall be obtained on a per occurrence basis unless that field trip is part of the regular program (i.e. bowling each week, swimming each week, etc.)4. Emergency medical releases must be taken on field trips or incorporated in the field trip release.C. Statement of Legal (competency) status; See Ark. Code Ann. §§ 28-65-101 - 28-65-109 (see index) 1. If the individual is under the age of 18, he she is a minor. Organizations shall determine the who is the legal guardian of the child: Natural parent(s), ward of the state (DCFS foster home, etc.) and shall ensure the legal guardian signs all appropriate documents.2. If the individual is age 1S or older, he she is considered competent unless the court has appointed a legal guardian. Copies of guardianship orders must be maintained in the individual's record. Note: An individual for whom a guardian has been appointed retains all legal and civil rights except those which have been expressly limited by court order or which have been specifically granted by order of the court to the guardian.
505 Application for services A. The organization shall develop and implement a written application to be made available upon request or presented to those requesting services. At a minimum, the application shall contain name, address and telephone number of individual parent guardian and a statement of the individual's needs. Applications shall be available in an alternate format and assistance to complete shall be offered to individual's that may require it506 The organization shall complete a Financial Screen for all applicants for services as applicable. A. The screen shall be completed prior to admission and is used by the program in the evaluation of a person's financial statusB. The organization shall include all information about benefits for Medicaid eligibility and, for individuals who may not be eligible for Medicaid, shall include information about Tax Equity Family Reform Act eligibility.507 Medical prescription for services shall be obtained, if applicable A. A current prescription for services (within twelve months), signed by qualified medical personnel, shall be on file prior to admission508 The organization shall complete or obtain a full assessment at the time of the admission process. The assessment shall include the following items: A. Social history 1. A social history shall be written or procured within thirty (30) days of admission. The social history must be comprehensive, in narrative form or a completed questionnaire. The social history must be updated annually as evidenced by dated signature. B. Medical history and evaluation 1. A physical examination assessment signed by qualified medical personnel shall be on file and current within 5 days but not longer than thirty (30) days afier admission. In cases where a physical cannot be obtained within 5 days, documentation of a phvsical within 1 year will be accepted until a new physical can be obtained2. Early Periodic Screening Diagnosis Treatment process for Medicaid eligible individuals (0-21) a. All individuals 0-21 vears of age eligible for Medicaid should have evidence in the file that they are participating in the EPSDT process509 A psychological evaluation report shall be on file prior to admission for adults (age IS and older) and for children (age 5-18) if applicableA. Adults (age 18-up) transferring from a DDS Licensed provider may be admitted with a copy of the most current ps[GREATER THAN]chological evaluationB. A new psychological evaluation may be conducted if an Interdisciplinary Team determines that it is reasonable and necessary based on significant life changes of the individual.510 Therapy evaluations must be completed or procured within thirty (30) days after admission, when applicable or when prescribed by a physician or a therapist working under a physician's orders. Recommendations from therapy evaluations shall be incorporated into the individual's plan of care as appropriate.511 When applicable, all psychiatric evaluation shall completed by a qualified person and must be on file within thirty (30) days after admission. Recommendations from psychiatric evaluations shall be incorporated into the individual's plan of care as appropriate.512 The service needs assessment must be completed on every individual seeking services NOTE: See Section 521 for further guidelines
(Children's services Section).
A. The person and. or family served and/or their legal representatives shall be involved in: 1. Assessments of potential risks to each person's health in the setting in which they receive services as well as in the community2. Assessments of potential risks to each person's safety in the setting in which they receive services as well as the community3. Decisions to accept or reject such risks4. Identification of actions to be taken to minimize risks5. Identi fication of individuals responsible for those actions513 Personal Futures Planning Guiding Principle: Individual's with developmental disabilities and their families have competencies, capabilities and personal goals that shall be recognized, supported, encouraged, and any assistance to such individual's shall be provided in an individualized manner, consistent with the unique strengths, resources, priorities, concerns, abilities, and capabilities of such individuals. Any plan of service developed should significantly reflect the person for whom it is intended. Services/ supports are most effective when they are adapted lo address individual outcomes
1. The organization shall prepare a written person-centered support plan for each individual that shall meet their individual needs. At a minimum, the plan shall:A. Be developed only after consultation with the individual parent/guardian, and other individuals from the individual's support network as determined by the individual parent, guardian;B. Contain a description of the individual's preferred lifestyle, including: 1. The type of setting in which the individual wants to live or work;2. With whom the individual wants to socialize;3. The social, leisure, religious, or other activities in which the individuals wants to participate;4. Reflect the individual's / family's choice of services which are relevant to the individual's age, abilities, life goals/outcomes5. Address areas such as the individual's family's health, safety and challenging behaviors which may put the individual at risk6. Demonstrates the rights and dignity of individual family7. Incorporates the culture and value system of the individual family8. Ensures the individual's, family's orientation and integration to the community, its sen ices and resources.9. The necessary activities, training, materials, equipment, assistive technology and services needed to assist the individual in achieving their preferred lifestyle;10. Describes how opportunities for individual choice will be provided;11. Be approved, in writing by the individual parent guardian. 2. The organization shall regularly review and revise the plan whenever necessary to reflect changes in the individual's preferred lifestyle; achievement of goals or skills outlined within the plan or the goal is no longer deemed appropriate for the individual 514 Every individual shall have a written Individualized Program Plan NOTE: See individi At. program sections for specific time frames (Children's services. See Section 521).
A. The organization shall include the person served as an activ e participant giving direction in all aspects of the planning and revision processesB. Services shall be provided based on the choices of the individual parent guardian (as appropriate) and on the strengths and needs of the individuals to be served by the organizationC. Individual choice shall be determined bv personal futures planning as specified in Section 513 and a comprehensive assessment which addresses: 1. Relevant medical history2. Relevant psychological in formal ion3. Relevant social information4. Information on previous direct services and supports11.Other issues, as identified514.1 The Individualized Program Plan A. Shall be developed with the input of the person served and or their legal guardian. B. Shall Identify: 1. Least restrictive emironment a.Documentation of discussion of least restrictive environment appropriate for individual strengths and needs b.The program must document the justification for specialized environments if they are to be used. Plans shall be made for return to normal environments as soon as possible. 1.Individuals shall be in contact as much as possible with those who do not have disabilities2. Individual program plans will be reviewed for provisions of program services in the least restrictive environment appropriate to the ability of the individual. Document this item with a summary of the discussion by the entire team about the least restrictive alternatives3. If the person chooses community integration or a less restrictive environment, documentation of referral attempts for alternate placement shall be present 2. Barriers a.Describe the conditions or barriers that interfere with the achievement of the goal(s) or skills(s). Describe why a particular individual's needs cannot be met or what needs to be accomplished to meet the need. b. Resources and or environment changes, adaptations or modifications necessary to attain the goal or skill shall be listed. The person responsible for attempting to get the service must be identified. Note: Example of barriers are: lack of contract work, lack of funds, lack of staff, individual absent due to illness, prosthetic devices, equipment space, etc. The responsible person may be staff member, individual, family, etc.
c. Documentation of efforts made to remove the identified barriers shall be noted in the individual's progress reports.3. Long-range goals (addressing a period of 3-5 years) and annual goals a. The plan shall incorporate the goals and objectives of the individual's person centered plan. b. The planning process shall support the individual / family in decision making and choosing options by actively involving the individual family in the Individual Plan (IP) development4. Specific measurable objectives.514.2 Short-term objectives (3-6 months* time frame) shall be developed, as needed, for each of the annual goals. A. Each objective must have criteria for success that states what the individual must do to complete the objective.B. Short-term objectives must have methods- materials for implementation and give a simple statement describing the procedures to be used in individual training.C. The person responsible for implementation of each short-term and service-objective shall be specified. Note: Utilization of title is recommended. This could be the individual or parent/guardian.
D. Short-term objectives shall have an initiation date, a target date, and, when completed, a completion dateE. Target dates - 1. The target date shall be individualized and noted at the same time of the initiation date and the projected date when the individual can realistically be expected to achieve an objective.2. The target date shall be used as a prompt to see if expectations for the individual are realistic in relation to attainment and appropriateness of goals and objectives. If the starting or target dates need to be revised, the organization shall mark through, initial and put in a new date.3. The ending date shall be entered in as the person completes each objective.514.3 Service Objectives A. Shall be reviewed on a regular basis with respect to expected outcomes.B. Shall be revised, as appropriate:1. Based on the satisfaction of the person served.2. To remain meaningful to the person served.3. Based on the changing needs of the person served.C. Shall include a target date, which is a projected date when the team thinks the individual will no longer need the service or the service provision should be reviewed.514.4 The following areas shall be assessed to determine needs in the plan and shall be documented: B. Reasonable accommodations.C. Identified health and safety risks514.5 The individual program plan shall be communicated in a manner that is understandable: A. To the person served and or their guardian advocate/ representative.B. To the persons responsible for implementing the plan.514.6 The organization shall ensure that persons in\ oh ed or their legal guardian/advocate understand the plans and their own involvement in achieving the outcomes. A. Active participation of the persons served, or their guardian or advocate in setting goals and planning services shall be documented. Documentation may be through interviews, records, checklists, etc. and shall be maintained in the individual's file B. If a person served needs services that are not available through the organization, the organization shall make referrals to other providers as indicated, Documentation of the referral(s) shall be maintained in the individual's file.NOTE: Com ,\c i DDS roK a usrni: providers that provide mi: RIQUSIIDSIRYK k.
515 Every ninety (90) days of serv ice delivery, the serv ice provider shall complete a quarterly report on the goals, objectives of the 1PP. If needed, modifications may be made with meeting of entire team. Quarterly reports must be specific to rcllcct the individual's performance concerning implemented goals and short-term objectives as specified in the individual program plan and shall be based on the case notes for the reporting period. A. The quarterly notes shall establish goals or short-term objectives which are: 3. Modified or deleted (with statement of reason or barrier) and4. Will be worked on for the next three months or ninety (90) daysB. Data Collection/case notes shall be utilized in writing progress reports.C. Quarterly reports shall be written, dated, and signed by persons responsible for case management. All persons responsible for implementation of services must contribute to the report.D. Quarterly reports shall document referral to interdisciplinary team for modification of the annual goals as needed, in compliance with state and federal regulationsE. Documentation of communication of quarterly reports to the individual parent/guardian (as appropriate) shall occur at least every three (3) months or ninety (90) days as in compliance with state and federal regulations.F. Quarterly reports must include space for individual and/or parental/guardian evaluation of services. The organization shall document that the persons served and or the parent guardian has opportunity to evaluate the services received as in accordance with state and federal guidelines.516 Updating A. The organization shall have policies and procedures in place for updating individual program plans. Updates shall be done at least annually and more often if monitoring reports indicate a need or if federal regulations require more frequent updates.B. The organization shall have policies and procedures in place for revising individual program plans when goals change.C. Annually update - financial, if applicable, social, medical, medical prescription for services, evaluations as applicable, IPP's, and service needs assessment;517 Termination of services or alternate placement NOTE: SKI: Till: SPECIFIC PROGRAMMING SIC I ION FOR MORE DETAILED INFORMATION (CHILDREN'S SIRVKT-S 521).
A. An exit summary shall be prepared each time a person leaves a service, not just when the person is leaving the organization. 1. The report shall summarize the results of the services received by the person and makes recommendations for future services to continue the achievement of the person's life goals.2. The plan may suggest referrals to other services that are not available through the organization518 Data Collection Requirements A. Data collections shall provide specific information on annua] goals and short-term objectives and should be designed to measure and record the progress on each short-term objective.B. Data collection shall consist of sufficient written documentation to support each. Daily service documentation must, at a minimum, include: * The specific services furnished;
* The date and actual beginning and ending time of day the services were performed;
* Name(s) and title(s) of the person(s) providing the service(s);
* The relationship of the services to the goals and objectives described in the person's individualized plan of care and
C. Data collection shall also consist of weekly or more frequent progress notes, signed or initialed by the person providing the service(s), describing each individual's status with respect to his or her goals and objectives.D. Data Collection shall be filed in the individual's file at least monthly and shall be available for review upon request.520 The organization shall establish and maintain each individual's daily schedule based upon the individual's program plan. The schedule shall indicate general activities throughout the day for each individual. As appropriate the schedule should reflect time segments for the individual to exercise choice in the selection of activities.521Children's Services Individual Program PlanningAs a key element in establishing goals objectives personal outcomes, the agency shall assess an individual's family's preferences, desires, lifestyle choices, strengths, needs, skills, etc. through individual observations or interviews. Documentation of the assessment shall be maintained in the individual's file. At a minimum, the assessment must include:
A. Developmental Assessment 1. Initial evaluation shall include 2 developmental assessments; I standardized and 1 criterion based.2. Documentation must include: a. A written summary that includes standard deviation and or percentage of delay as determined by the test protocolsb. An informed clinical opinion3. Must be in a format that is understandable to the parent.4. Must be signed by the evaluator.B. An annual assessment must be conducted using a criterion based test,C. A Social History must be completed, signed and dated on the approved form from DOE.521.1 Children 3-5-The Individual Program Plan shall include a statement of the specific services necessary to meet the identified needs of the child family, A. At a minimum the IPP must include: 1. Frequency- Number of days or sessions that a ser\ ice will be provided2. Intensity- The length of time the serv ice is prov ided during each session, and whether the service is provided on an individual or group basis3. Location- Location where the service is provided (e.g., in the child's home, early intervention center, or other setting) as appropriate to the age and needs of the child4. Method- How a service is provided5. Dates and duration- Projected dates of initiation of the services, a target date for completion and or review and the anticipated duration of those services. If either of these dates needs to be revised, then simply mark through, initial and put in new date. B. Completion of the IPP must meet all State and Federal requirementsC. In order to revise an individual's objectives, at least three (3) members of the team must be present. Parent(s) must be included.521.2 Quarterly reviews must include a Family Rating which must be documented on the appropriate form as designated by DDS.521.3 Children reaching 5 years of age must hav e a transition plan. A. This plan must be developed 180 days prior to age 5 as per State and Federal guidelines.B. The plan must be child specific and must include specific steps to ensure a smooth transition for the child and family, and must be in accordance with State and Federal Guidelines.C. The plan must include a transition plan at kindergarten age. Children entering public schools must have a transition plan.D. The individual program shall include the steps to be taken to support the transition of the child upon reaching kindergarten age.E. The organization must document contact with the agency which will provide services following the transition, and must demonstrate an attempt to involve that agency in the transition planning. Documentation must be maintained in the individual's file.521.4 If the organization is using the supervising teacher model, the organization must follow all State and Federal Guidelines and maintain appropriate documentation of supervision and direct contact with the child on file for review.522Vocational Maintenance & MonitoringVocational Maintenance & Monitoring
A. Case Notes 1. Case notes shall document each contact with the individual the frequency of each contact will be determined by ihe team during the development of the IPP it should include date, time and summary of each contact.2. Service Objectives shall be listed in an outcome oriented manner. A. Each service objective shall specify any environment modification necessary to facilitate Ihe individual's accomplishment.B. Each service objective, including physical adaptations or modifications of the individual's environment, shall be stated as a single specific outcome.C. Service objectives shall provide opportunities in the social environment to support community integration and the enhancement of individual relationships. D. Based on the individual's choice, and die needs assessment, plans shall include facilitation of the individual's participation in normal activities in normal settings of same-age peers.523.1 Staff Ratios for Early Intervention Day Treatment Day Programming: Ratios for Day Programming for Children 0-18 months 1:4
Ratios for Day Programming for Children 18-36 months 1:5
Ratios for Day Programming for Children 3-4 Years 1:7
Ratios for Day Programming for Children 4-6 1:8
Ratios for Day Program for Children 6 and over 1:10
523.2 Ratios for Adult Developmental Day Treatment Day Programming The organization shall maintain a 1:10 ratio throughout the building.523.3 For all Day Programming The Direct Care Staff must have VISUAL CONTACT WHILE ACTIVELY ENGAGED IN PROVIDING SUPPORT AND SUPERVISION TO CONSUMERS.
524Square FootageA minimum of forty (40) square feet of program training area per individual served shall be required. This is program-training area only. This does not include halls, storage areas, or administrative offices.
600FOOD SERVICESA. This standards section shall be applied to all provider owned leased, rented facilities. If the facility contracts for food services, the organization shall ensure compliance with DDS policies.601 Written procedure shall be established that addresses how food services are provided to the individuals served by the facility: A. Procedure shall include how meals are provided as well as staff responsible.601.1 All Day services programs shall assure that organization provided meals are approved, adequate diets, which conform to the recommended dietary allowance.601.2 Licensed Group Homes shall assure that three (3) meals a day are available for individuals served. A. The organization shall keep on hand suitable food for preparing sack lunches, if appropriate.B. All meals shall be part of an approved, adequate diet, which conforms to the recommended dietary allowance.C. Facilities with apartment units shall have a mechanism for monitoring the resident's food related skills.602 The organization shall keep menus on file Menu preparation should occur at least one week in advance in order to: A. Allow adequate time to purchase foods to avoid too frequent menu substitutions. Meal planning shall occur so that identical meals are not served on the same day of consecutive weeks.B. Serve as a reminder for scheduling advance preparation;C. Allow menus to be available as a teaching tool for instruction of individuals, to include development of menus by individuals. Menus shall be kept on file for a minimum of three (3) months.
603 Menus shall be prepared or approved by a registered dietitian/nutritionist. Organizations may contract with a dietitian, nutritionist. A. Dietitian/nutritionist shall check for nutritional adequacy of menus and acceptable food safety and sanitation practices. This must be documented by a written report at least annually.B. DDS shall accept Arkansas Nutrition Program approval, or site monitoring reports, as adequate approval for Centers that participate in the free/reduced lunch program.604 The organization shall develop and implement written procedures that address provisions for special diets. A. Special diets pertain to allergies, weight control, diabetes, religion, hypertension, and other medical conditions as documented in the consumers file.605 Food items and toxic items shall not he stored together.700TRANSPORTATIONA. The organization shall establish written procedures that address how transportation services are provided to individuals served by the program.B. The procedures shall address transportation to the persons served, as well as staff responsible.C. The organization shall ensure that all individuals receiving services are provided with a copy of the transportation policies and shall document receipt of this information in the individual's file.701 The organization shall assure safety for all persons being transported. For all transportation services provided for the persons served by the organization, the organization shall ensure: A. For all vehicles owned or operated by the organization: 1. Compliance with all applicable federal, state, county, and city requirements, a. All vehicles shall be properly licensed by the State of Arkansas.2. Appropriate licensing of all drivers. a. All drivers must be licensed according to state requirements for providers of public transportation.3. Review of driving records of all drivers on an initial and annual basis.4. Insurance requirements for vehicles and personnel. a. The organization shall maintain insurance coverage providing a minimum of SI,000,000 comprehensive, liability, and property damage.5. Safety equipment / features in vehicle(s). a. Fire extinguisher in every program vehicle used to transport consumers.b. Each vehicle shall utilize scat belts or suitable restraints when in motion in accordance with Ark Code 27-37-702 "Seat Belt Use Required" and 27-34-101 -107 "The Child Passenger Protection Act"c. The organization shall establish policy and procedure to ensure Child Safety Alarms on every vehicle required under Ark Code 20-78-225 (all vehicles designed or used to transport more than 7 passengers and I bus driver)6. Accessibility based on the individual's needs and reasonable requests.7. Training of drivers in the organization's transportation requirements.8. Written emergency procedures. a.Each vehicle used in transporting clients shall have a documented emergency drill once every six months.9. Availability of communication devices (i.e., cell phones 2-way radios, etc.).10. Road warning/hazard equipment (i.e., safety cones. Hairs, reflector signs, etc.)11. First aid supplies. a. Every program vehicle used to transport consumers shall maintain a First Aid kit. 12. Maintenance of vehicles owned or operated by the organization according to manufacturers' recommendations. a. The organization shall establish implement procedures that ensures a vehicle maintenance log is kept up to date for all vehicles used to transport consumers.1. The procedure shall establish who is responsible for upkeep of vehicle and who is responsible for documentation and update of log. b. The maintenance log shall document the following: 2. Tires and brakes repair inspection3. Head and tail lights and turn signals repair-inspection4. Windshield washer and wiper blades repair/inspection5. Air conditioner (if any), and defroster inspection/repair6. Hoses and fan belts inspection/replacement7. Fluid levels inspection and replacement8. Exhaust system inspection, repair9. Emergency warning system inspection, repair10. Steering assemblage inspection repair 13. If services are contracted; a. An annual review of the contract against elements 1-12 of this standard shall be performed by the organi/ation.b. Personnel or contractors shall provide transportation services for the persons served in a safe manner, with drivers having knowledge of unique needs of persons served, and consistent with the regulations of the local authorities, 1. This standard shall apply when any vehicle, including a personal vehicle, is used to provide transportation for persons served.702 The organization shall establish written policy and procedure to address apparent abandonment of consumer by family and or guardian. A. The organization shall develop a procedure to be followed by transportation staff when unable to leave individuals at home or alternate sites as specified by family that ensure the safety of the individual at all times.703 At least one responsible person, in addition to the driver, shall be present in the vehicle if any of the following conditions apply: A. Any person being transported has medical conditions as defined by the organization guidelines.B. Any person being transported has a severe disability as defined by the organization's guidelines. NOTE: 'Responsible person ' shall he defined hy the organization 's policy,
704 Organizations operating vehicles transporting children shall comply with the child:staff ratio specified by the Child Care Licensing Standards for Transportation705 Organizations operating vehicles transporting adults shall establish implement policies related to adult: staff ratios. NOTE: DDSrecouuesds t1 roll) ft trio tr \u. nuns.
800Physical Plant, Accessibility and SafetyA. The organization shall provide a physical plant compatible with services provided and with the needs of the individuals and staff; provide an accessible and safe environment and be in compliance with U.S.C. § 12101 et. seq. "American with Disabilities Act of 1990" at all owned, leased, and/or rented program site(s).801 The organization shall promote accessibility in all settings. The organization shall assess all physical sites to ensure accessibility for individuals and their families and shall establish time lines and actions to be taken for removal of identified barriers. A. Organizations shall ensure that all physical sites address accessibility issues in order to: 1. Enhance the quality of life for those served in their programs and services.2. Meet legal and regulatory requirements.3. Meet the expectations of stakeholders in the area of accessibility.801.1 Accessibility Requirements A. The organization shall ensure architectural accessibility at each facility based on the individual's needs. 1. Ramps, doors, corridors, toileting and bathing facilities, furnishings, and equipment are designed to meet the individual's needs.B. The organization shall ensure that all their facilities are in compliance with 29 U.S.C. §$ 706 (8), 794 - 794(b) "Disability Rights of 1964" and U.S.C. § 12101 et. seq. "American with Disabilities Act of 1990". Compliance with the aforementioned laws is required to receive federal monies. Admissions criteria of who can be served shall identify any persons the facility or staff would be prevented from serving due to accessibility issues.801.2 Accessibility Assessment and Planning A. The organization shall assess all facilities. The assessment shall identify all barriers and shall develop a plan for removal of barriers in the following areas: 1. Architecture a. Architectural or physical barriers which may include steps that prevent access to a building for an individual who uses a wheelchair, narrow doorways that need to be widened, bathrooms that need to be made accessible, the absence of light alarms for individuals who have a hearing impairment, and the absence of signs in Braille for individuals who have visual impairments.2. Environment a. Any location or characteristic of the setting that compromises, hinders, or impedes service delivery and the benefits to be gained. 802 Physical Plant Structure802.1 Architecture A. All water, food service, and sewage disposal syslems must meet all local, state, and federal regulatory agencies, as applicable. The organi/alion shall maintain documentation of all approved inspections for review by DDS. 1. Sewer inspections are not required if the site is on city water and sewage lines.2. Sites using a well and. or septic tank, shall be obtain an inspection by the Division of Health documenting compliance with the DOH and local regulations.B. Floor furnaces, gas heaters, electric heaters, hot radiators, and exposed water heaters must be protected by screens or guards that are without sharp corners and are attached to floor or wall to prevent persons from falling against the guard and knocking it over.C. Enclosed gas heaters must be properly vented to the outside, and installed with permanent connection that includes a cut-off valve in the rigid part of the gas supply pipe. Note: DDS recommends gas heaters with a pilot light and automatic cut-off valve which automatically cuts off gas to the main burner when the pilot light goes out.
D. Restroom facilities used by individuals must provide for individual privacy and be appropriate for the individuals served regarding si/e and accessibility.802.2 Environment A. Temperature of each facility must be maintained within a normal comfort range for the climate. Recognizing that there may be variances within a building, the organization shall make reasonable efforts to maintain a comfortable temperature range throughout the facility. Note: The recommended standard for range oj comfort is from 65 to SO degrees F (U.S. Atmospheric Standards 29.1)
B. All areas of the facility shall be sufficiently lighted to meet the needs of the individuals being served and the usage of the area.C. The organization shall maintain the interior and exterior of the building in a sanitary and repaired condition.D. The premises shall be free of offensive odors.E. The grounds and all buildings on the grounds shall be maintained in a clean and repaired condition. 1. Play and activity areas shall be free of dense undergrowth and refuse accumulations. All landscape plantings and the lawn shall be well groomed.F. The facility shall be maintained free of infestations of insects and rodents.1. The organization shall maintain a contract for pest control that is administered by appropriately licensed professionals.G. The organization shall establish written procedures regarding smoking that is in accordance with The Clean Air Indoor Act (Act 8 of 2006). 1. For all congregate, day-hab settings, anil licensed group homes, smoking will not be permitted in the following areas:d. Conference and Meeting Roomsh. Health Care Facilitiesm. All other enclosed areas.2.Approved Exemptions: a. Private residences or health care facility b. All workplaces of any employer with fewer than three (3) employees. (Note: This exemption does not apply to any public place)c. Outdoor areas of places of employment or group homesH. All materials and equipment and supplies shall be stored and maintained in a safe condition. Cleaning fluids and detergents must be stored in original containers with labels describing contents.1. The organization shall maintain an MSDS manual in a location that is accessible to all employees. All MSDS sheets must be on file and current. 803.1 The organization shall ensure that annual safety inspections are completed by qualified individuals to enhance and maintain the organization's health and safety practices. A. All applicable inspections shall be maintained on file, and current within one year or as specified by law regulation {i.e., Annual Fire Department, Local Health Department, Safety Engineer, OSHA, Safety Specialist, and Insurance Carrier).B. A comprehensive inspection shall be conducted annually at all facilities where the organization delivers services or provides administration on a regular and consistent basis. Inspections shall be conducted by a qualified external authority(ics). 1. Results of each inspection shall contain written documentation that: a. Identifies the areas inspected.b. Identifies recommendations for areas needing improvement.c. Identifies actions taken to respond to the recommendation(s).C. All applicable licenses, inspections, etc., shall be current. This shall include health inspections for food service preparation, if applicable. Residential facilities with more than ten (10) residents must have a Division of Health inspection.803.2 Regular self-inspections shall be completed to assist personnel in internalizing current health and safety requirements into everyday practices. A. The organization may designate professional personnel (managers, supervisors, direct service employees, maintenance personnel) or internal groups (safety committees, safety circles, operation teams, consumers or advocates) within the organizational structure to conduct self- inspections. The organization shall ensure that all staff involved in self-inspections have received training in conducting inspections prior to participation.B. The organization shall maintain a schedule of when self-inspections will be conducted.1. At a minimum, self-inspections must be conducted: a. At least twice a year.b. At all facilities where the organization delivers services or provides administration on a regular and consistent basis.2. Results of self-inspections shall contain written documentation that: a. Identifies the areas inspected.b. Identifies recommendations for areas needing improvement.c. Identifies actions taken to respond to the recommendation(s). 804.1 The organization shall establish emergency procedures that detail actions to be taken in the event of emergency and to promote safety for the individuals served. A. Emergency procedures shall be in written form, and shall be available and communicated to all members of the staff and other supervisory personnel.1. At a minimum, emergency procedures shall be implemented for: f. Safety during violent or other threatening situations (i.e., intruders)2. Written emergency procedures shall: a. Meet the requirements of all applicable authorities.b. Implement practices appropriate for the locale (i.e., Arkansas Chemical Stockpile Emergency Preparedness Program CSEPP)B. The organization shall maintain an emergency alarm system for each type of drill (fire and tornado).C. The organization shall ensure that persons served, as appropriate, are be educated and trained about emergency and evacuation procedures.D. The organization shall evaluate and consider modification of all emergency procedures during the following times: b. After training drills.d. Alter actual emergencies.e. When responsibility is reassigned,f. When changes are made to the physical plant.g. When changes occur in the physical plant proximity, h. When a policy or procedure is revised,i. When briefing personnel on emergency plan changes.E. The organization shall analyze tests of the emergency and evacuation procedures annually and shall use the results of the analysis to improve or to affirm satisfactory current practices. 804.2 For all facilities where the organization delivers services or provides administration on a regular and consistent basis, the organizations shall establish'implement written procedures for evacuations, A. Evacuation procedures shall address:1. When evacuation is appropriate2. Complete evacuation from the physical facility,3. The sa lety of ev acuccs.4. Accounting for all persons involved.5. Temporary shelter, when applicable.6. Identification of essential services.7. Continuation of essential services.8. Emergency phone numbers.9. Notification of the appropriate emergency authorities. B. Evacuation routes must be posted in conspicuous places, except in residential settings and must be easily understandable to the individuals served.804.3 As a part of an organization's performance improvement activities shall include emergency procedure testing.A. A tornado drill must be held monthly. 1. Written reports telling date, hour of day, evacuation time, and other areas of concern shall be maintained.B. A fire drill must be held monthly. 1. Written reports telling date, hour of day, evacuation time, and other areas of concern shall be maintained.804.4 Detectors Battery operated or electronic smoke detectors, heat sensors, carbon monoxide detectors and/or sprinklers shall be provided in all buildings where services are provided and shall meet life safety codes.
A. Fire Marshall's report shall be followed as to placement of these devices.B. Equipment shall be tested at least quarterly or as recommended by the manufacturer monitoring contractor.804.5 Fire Extinguishers Fire extinguishers shall be required to the extent specified by the State Fire Marshall or his designee and shall be checked annually.
A. The Fire Marshall uses Ark. Code Ann. §$ 12-13-101 - I2-I3-116 "Fire Prevention Act" that follows the Life Safety Code 101 and additional National Fire Prevention Agency publications.
804.6 Emergency Lighting The organization shall maintain emergency lighting, (i.e., flashlight or other battery operated lights) as required by the life safety codes.
804.7 First Aid The organization shall maintain a first aid kit and current first aid manual at all sites where services are provided on a regular, consistent basis.
A. Antidote charts and the telephone numbers of poison control centers shall be readily accessible to staff and individuals served. Note: This can he obtained through Poison Control Center at University of Arkansas
Medical Science Center in Little Rock if you cannot get locally.
804.8 Water Temperatures Provisions shall be made to control water temperature at facilities where services are provided on a regular, consistent basis.
A. To ensure the safety of individuals served, each organization shall develop, implement policy and procedure concerning water temperature adhering to current literature regarding water safety with a maximum temperature of 120 degrees. If the thermostat of the hot water heater is set above 120 degrees, a mixer must be to the lavatories and bathing facilities to maintain safety. Note: This standard shall apply only to sen ice areas and where consumers are working.
APPENDIX A
SUGGESTED BOARD/ORGANIZATION TRAINING TOPICS
Policy Development and Implementation
Planning and Evaluation
Equal Employment Opportunity/Affirmative Action
Employee Performance Evaluation
Team Building
Performance Management
Effective meetings
Due Process
Freedom of Information
Overview of Department of Human Services
Overview of Developmental Disabilities Services
Philosophy and Goals
Programs, Practices, Policies and procedures of Local Organizations
Overview of Community Integration
History, Philosophy, Causes and Types, Functional Levels, Severity Levels. Prevention and Program Issues in Mental Retardation and Other Developmental Disabilities.
Introduction to Principles of Normalization
Legal rights of Individuals with a Developmental Disability
Interdisciplinary Approach Overview
Age Appropriate Programming
Medications - Implications, Side Effects, legality of Administering
Overview of Federal and State Laws related to serving people with Developmental Disabilities (see index):
U.SC S2000a - 2000 h-6; Ark. Code Ann SS 6-41-222: 20 U.S.C S 14000 et. seq (Part B & Part H); 29 USC SS 706(8), 794-794{b);
5 USC S 552a; 42 U.S.C SS 6000-6083. Ark Code Ann SS 20-48-201 - 20-48-211; Ark Code Ann SS 28-65-101 - 28-65-109; Ark. Code Ann. SS 5-28-101 - 5-28-109; Ark Code Ann SS 12-12-501 - 12-12-515, Ark Code Ann. SS 25-2-104, 25-2-105, 25-2-107, Ark Code Ann SS 25-10-102 - 25-10-116; Ark. Code Ann SS 20-18-215; USC. S 12101 et. Seq.; DHS Administrative Policy 3002-I (Revised) and DDS Service Policy 3016, Prevention of Transmission of Disease Borne by Blood or other Body Fluids such as AIDS and Hepatitis B, DDS Administrative Policy 1077 Chemical Right to Know; DDS Service Policy 30044 Maltreatment Prevention, Reporting and Investigation.
ATTACHMENT 3.1-A
STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM STATE ARKANSAS
AMOUNT, DURATION AND SCOPE OF SERVICES PROVIDED
9. Clinic Services (1)Adult Developmental Day Treatment (ADDT) ServicesLimited to comprehensive day treatment centers offering the following scope of services to beneficiaries age 18 and above:
a. Diagnosis and evaluation c. Provision of noon meal Optional Services available through ADDT in conjunction with core services are as follows:
a. Physical therapy - Services must be prescribed by a ph[GREATER THAN]sician and provided by or under the supervision of a qualified physical therapist.b. Speech therapy - Services must be referred b[GREATER THAN] a physician and provided by or under the supervision of a qualified speech pathologist.c. Occupational therapy - Services must be prescribed by a physician and provided by or under the supervision of a qualified occupational therapist.ATTACHMENT 3.1-B
STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM STATE ARKANSAS
AMOUNT, DURATION AND SCOPE OF SERVICES PROVIDED
9. Clinic Services (1)Adult Developmental Day Treatment [LESS THAN]ADDT) Services Limited to comprehensive day treatment centers offering the following scope of services to bcneflciarics age 18 and above:
a. Assessment, 1 unit per yearb. Adult I iabilitativc Services, 5 units per day, 1 hour each dayc. Provision of noon meal Optional Services available through ADDT in conjunction with core services are as follows:
a. Physical therapy-Services must be prescribed by a physician and provided by or under the supervision of a qualified physical therapist.b. Speech therap[GREATER THAN]-Seniccs must be prescribed by a physician and provided by or under the supervision of a qualified Speech Pathologist.c. Occupational thcrap[GREATER THAN] -Services must be prescribed by a physician and provided by or under the supervision of a qualified Occupational therapist.d. Nursing services-Sen ices must be prescribed by a physician and provided by a registered nurse or a licensed practical nurse. All nursing services must be prior authorized.Eflectivc for dates of services on or afWr July 1,2017. individual and group therapy arc limited to six (6) units per week. One unit equals 15 minutes, livahiations are limited to four (4) units per Stale Fiscal Year (July 1 through June 30). One unit equals 30 minutes, rxlensioiisofthebenellt limit will be provided if medically necessary.
ATTACHMENT 4.19-B
STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM STATE ARKANSAS
METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES -
OTHER TYPES OF CARERevised:July 1,2018
8. Private Duty Nursing Services (Continued) Refer to Attachment 4.19-B, Item 4.b.(5) for reimbursement information for private duty nursing services for high technology non-ventilator recipients in the EPSDT Program.
9. Clinic Services (1)Adult Developmental Day Treatment (ADDT) and Early Intervention Day Treatment (EIDT)Reimbursement is based on the lesser of the amount billed or the maximum Title XIX (Medicaid) charge allowed. The Title XIX maximum was established based on a 1980 survey conducted by Developmental Disabilities Services (DDS) of 85 Arkansas Developmental Day Treatment providers of their operational costs excluding their therapy services. An average operational cost was derived for each service. Then an average number of units was derived for each service. The average operational cost for each service was divided by the average units for that particular service to arrive at a maximum rate.
For dates of service occurring on or after February 1, 2010, the maximum per unit rate for Adult Habilitativc Services is increased to SI 0.60. These new rates were calculated based on analysis of the current 2005 cost to provide quality services in compliance with governing regulations. The rates have been demonstrated to be consistent with the Clinic Upper Payment Limit at 42 CFR 447.321.
For EI DT and ADDT, I unit of service equals I hour of service w ith a maximum of 5 units per day.
For EIDT, auditory, developmental and neuropsychological testing services listed in the 1990 Blue Cross/Blue Shield Fee Schedule that are not subject to the other specifically identified reimbursement criteria arc reimbursed based on 80% of the October, 1990 Blue Cross/Blue Shield Fee Schedule amounts. For those services that were not included on the 1990 Blue Cross/Blue Shield Fee Schedule, rates are established per the most current Blue Cross/Blue Shield Fee Schedule amount less 2.5% and then multiplied by 66%.
For EIDT, Psychological diagnosis/evaluation services arc reimbursed from the Rehabilitative Services for Persons with Mental Illness (RSPM I) Fee Schedule as described in Attachment 4.I9-B, Item I3.d.l.
For EIDT, Medical professional services reimbursement is based on the physician's fee schedule. Refer to the physician's reimbursement methodology as described in Attachment 4.19-B, Item 5.
For EIDT, The maximum rates for nutritional services are based on the entry-level salary for a Dietician (Grade 19). Department of Human Services position. The cost categories include Salary ($22,795), overhead and administration (52,276...using salary as the allocation base) and benefits ($4,559...using salary as the allocation base). These costs were allocated at 10% for overhead/administration and 20% for benefits. A 30 minute visit will equal one unit of services. As such, the unit of services rate is S7.12 as calculated by |S22,795 + 52,276 + 54,559 = 529,630/2080 (52 weeks x 40 hours per week) = 514.24 per hour. |
The maximum rate for nursing services is 514.30. Reimbursement for registered nurse and licensed practical nurses is based on the Private Duty Nursing Fee Schedule as described in Attachment 4.I9B, Item 8.
State developed fee schedule rates are the same for both public and private providers of EIDT and ADDT services.
Occupational, physical and speech therapy services under the EIDT and ADDT Program are reimbursed as is described in Item 4.b.( 19).
Extensions of benefits will be provided for all EIDT and ADDT services, If medically necessary.
016.05.18 Ark. Code R. § 002