016.06.16 Ark. Code R. 021

Current through Register Vol. 49, No. 12, December, 2024

Rule 016.06.16-021 - Living Choices Assisted Living Waiver Renewal and Living Choices Assisted Living Update #2-15

Section II Living Choices Assisted Living

200.105 Provider Assurances

A. Staffing

The Provider agrees that he or she will maintain adequate staffing levels to ensure timely and consistent delivery of services to all beneficiaries for whom they have accepted a Living Choices Assisted Living Waiver Plan of Care.

The Provider agrees:

1. Personnel responsible for direct service delivery will be properly trained and in compliance with all applicable licensure requirements. The Provider agrees to require personnel to participate in any appropriate training provided by, or requested by, the Department of Human Services. The Provider acknowledges the cost of training courses for certification and/or licensure is not reimbursable through DHS.

2. Each service worker possesses the necessary skills to perform the specific services required to meet the needs of the beneficiary he/she is to serve.

3. Staff is required to attend orientation training prior to allowing the employee to deliver any Living Choices Assisted Living Waiver service(s). This orientation shall include, but not be limited to, a:

a. Description of the purpose and philosophy of the Living Choices Assisted Living Waiver Program;

b. Discussion and distribution of the provider agency's written code of ethics;

c. Discussion of activities which shall and shall not be performed by the employee;

d. Discussion, including instructions, regarding Living Choices Assisted Living Waiver record keeping requirements;

e. Discussion of the importance of the Plan of Care;

f. Discussion of the agency's procedure for reporting changes in the beneficiary's condition;

g. Discussion, including potential legal ramifications, of the beneficiary's right to confidentiality.

B. Quality Controls

The Provider agrees to continually monitor beneficiary satisfaction and quality of service delivery and to document his or her findings in the beneficiary's record every ninety days via the Quarterly Monitoring Form (AAS-9506). View or print the AAS-9506 form.

C. Code of Ethics

The Provider agrees to develop, distribute and enforce a written code of ethics with each employee providing services to a Living Choices Assisted Living Waiver beneficiary that shall include, but not be limited to, the following:

1. No consumption of the beneficiary's food or drink;

2. No use of the beneficiary's telephone for personal calls;

3. No discussion of one's personal problems, religious or political beliefs with the beneficiary;

4. No acceptance of gifts or tips from the beneficiary or their caregiver;

5. No friends or relatives of the employee or unauthorized individuals are to accompany the employee to the beneficiary's assisted living facility apartment unit;

6. No consumption of alcoholic beverages or use of non-prescribed drugs prior to or during service delivery nor in the beneficiary's assisted living facility apartment unit;

7. No smoking in the beneficiary's assisted living facility apartment unit;

8. No solicitation of money or goods from the beneficiary;

9. No breach of the beneficiary's privacy or confidentiality of records. I

D. Home and Community Based Services (HCBS) Settings

All Level II Assisted Living Facilities licensed by the OLTC and participating in the Arkansas Medicaid waiver must meet the following Home and Community Based Services (HCBS) Settings regulations as established by CMS. The federal regulations for the new rule is 42 CFR 441.301(c) (4)-(5). Facilities who enroll in the waiver on or after the date of this policy change must meet these HCBS settings requirements prior to certification. Those facilities already enrolled in the waiver before this policy change must comply with the HCBS settings requirements under the timeframe established by the HCBS settings transition plan.

Settings that are HCBS must be integrated in and support full access of beneficiaries receiving Medicaid HCBS to the greater community, including opportunities to seek employment and work in competitive integrated settings, engage in community life, control personal resources, and receive services in the community, to the same degree of access as beneficiaries not receiving Medicaid HCBS.

HCBS settings must have the following characteristics:

1. Chosen by the individual from among setting options including non-disability specific settings (as well as an independent setting) and an option for a private unit in a residential setting.

a. Choice must be identified/included in the person-centered service plan.

b. Choice must be based on the individual's needs, preferences, and, for residential settings, resources available for room and board.

2. Ensures an individual's rights of privacy, dignity and respect, and freedom from coercion and restraint.

3. Optimizes, but does not regiment, individual initiative, autonomy and independence in making life choices, including but not limited to, daily activities, physical environment and with whom to interact.

4. Facilitates individual choice regarding services and supports and who provides them.

5. In a provider-owned or controlled residential setting (e.g., Assisted Living Facilities), in addition to the qualities specified above, the following additional conditions must be met:

a. The unit or dwelling is a specific physical place that can be owned, rented or occupied under a legally enforceable agreement by the individual receiving services, and the individual has, at a minimum, the same responsibilities and protections from eviction that tenants have under the landlord/tenant law of the State, county, city, or other designated entity. For settings in which landlord tenant laws do not apply, the State must ensure that a lease, residency agreement or other form of written agreement will be in place for each HCBS participant, and that the document provides protections that address eviction processes and appeals comparable to those provided under the jurisdiction's landlord tenant law.

b. Each individual has privacy in their sleeping or living unit:

i. Units have entrance doors lockable by the individual, with only appropriate staff having keys to doors,

ii. Beneficiaries sharing units have a choice of roommates in that setting,

iii. Beneficiaries have the freedom to furnish and decorate their sleeping or living units within the lease or other agreement.

c. Beneficiaries have the freedom and support to control their own schedules and activities, and have access to food at any time.

d. Beneficiaries are able to have visitors of their choosing at any time.

e. The setting is physically accessible to the individual.

f. Any modification of the additional conditions specified in items a through d above must be supported by a specific assessed need and justified in the person-centered service plan. The following requirements must be documented in the person-centered service plan:

i. Identify a specific and individualized assessed need.

ii. Document the positive interventions and supports used prior to any modifications to the person-centered service plan,

iii. Document less intrusive methods of meeting the need that have been tried but did not work,

iv. Include a clear description of the condition that is directly proportionate to the specific assessed need,

v. Include regular collection and review of data to measure the ongoing effectiveness of the modification,

vi. Include established time limits for periodic reviews to determine if the modification is still necessary or can be terminated,

vii. Include the informed consent of the individual.

200.230 Staffing Requirements for Living Choices Assisted Living Agencies

Living Choices Assisted Living Agencies have available two methods by which they may engage staff to furnish Living Choices bundled services.

A. The traditional method is using only employees, not contractors, to furnish the services. Its home health license confirms that the agency is qualified to provide home health services. The provider meets the state's qualification requirement by virtue of its licensure, and its enrollment as a Living Choices services provider, which is based on the agency's contract with a Level II ALF. These qualification criteria easily pass the CMS test of reasonableness.

B. Another method is to use both employees and contractors to provide services. Federal regulations allow home health agencies to contract for provision of component parts (but not all component parts) of the full service (home health) they are licensed to provide. However, the enrolled provider is held responsible for the provision of the service "in total" and each component of the service (whether furnished directly by the provider or by someone else under contract to the provider) must meet the applicable standards set forth by the Medicaid agency for the provision of that component of care.

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016.06.16 Ark. Code R. 021

9/26/2016