10 Colo. Code Regs. § 2505-10-8.501

Current through Register Vol. 47, No. 16, August 25, 2024

Section 10 CCR 2505-10-8.501 - [Repealed effective 9/14/2024] State Funded Supported Living Services Program

The State Funded Supported Living Services (State-SLS) program is funded through an allocation from the Colorado General Assembly. The State-SLS program is designed to provide supports to individuals with an intellectual or developmental disability to remain in their community. The State-SLS program shall not supplant Home and Community-Based services for those who are currently eligible.

8.501.ADefinitions

1. APPLICANT means an individual who is seeking supports from State-SLS program.

2. CASE MANAGEMENT AGENCY (CMA) means a public or private not-for-profit or for-profit agency that meets all applicable state and federal requirements and is certified by the Department to provide case management services for Home and Community-Based Services waivers pursuant to section 25.5-10-209.5, C.R.S., has a valid provider participation agreement with the Department, and has a valid contract with the Department to provide these services.

3. CCB CASE MANAGER means the staff member of the Community Centered Board that works with individuals seeking services to develop and authorize services under the State-SLS program.

4. CLIENT means an individual who meets the DD Determination criteria and other State-SLS eligibility requirements and has been approved for and agreed to receive services in the State-SLS program.

5. CLIENT REPRESENTATIVE means a person who is designated by the Client to act on the Client's behalf. A Client Representative may be:

(A) a legal representative including, but not limited to a court-appointed guardian, or a spouse; or

(B) an individual, family member or friend selected by the Client to speak for or act on the Client's behalf.

6. CORRECTIVE ACTION PLAN means a written plan, which includes the detailed description of actions to be taken to correct non-compliance with State-SLS requirements, regulations, and direction from the Department, and includes the date by which each action shall be completed and the individuals responsible for implementing the action.

7. COMMUNITY CENTERED BOARD (CCB) means a private corporation, for-profit or not-for-profit that meets the requirements set forth in Section 25.5 .-10-209, C.R.S. and is responsible for conducting level of care evaluations and determinations for State-SLS services specific to individuals with intellectual and developmental disabilities.

8. COMMUNITY RESOURCE means services and supports that a Client may receive from a variety of programs and funding sources beyond Natural Supports or Medicaid. This may include, but is not limited to, services provided through private insurance, non-profit services and other government programs.

9. COST EFFECTIVENESS means the most economical and reliable means to meet an identified need of the Client.

10. DEVELOPMENTAL DISABILITY (DD) DETERMINATION means the determination of a Developmental Disability as defined in section 8.607.2

11. DEPARTMENT means the Colorado Department of Health Care Policy and Financing, the single State Medicaid agency.

12. DEVELOPMENTAL DISABILITY means a disability that is defined in section 8.600.4.

13. EARLY AND PERIODIC SCREENING, DIAGNOSIS AND TREATMENT (EPSDT) means the child health component of Medicaid State Plan for Medicaid eligible children up to the age of twenty-one (21).

14. HOME AND COMMUNITY-BASED SERVICES (HCBS) WAIVER means services and supports authorized through a 1915(c) waiver of the Social Security Act and provided in community settings to a Client who requires a level of institutional care that would otherwise be provided in a hospital, nursing facility or intermediate care facility for individuals with intellectual disabilities (ICF-IID).

15. LONG-TERM CARE SERVICES AND SUPPORTS (LTSS) means the services and supports utilized by individuals of all ages with functional limitations and chronic illnesses who need assistance to perform routine daily activities such as bathing, dressing, preparing meals, and administering medications.

16. MEDICAID ELIGIBLE means an Applicant or Client meets the criteria for Medicaid benefits based on a financial determination and disability determination.

17. MEDICAID STATE PLAN means the federally approved document that specifies the eligibility groups that a state serves through its Medicaid program, the benefits that the state covers, and how the state addresses federal Medicaid statutory requirements concerning the operation of its Medicaid program.

18. NATURAL SUPPORTS means an informal relationship that provides assistance and occurs in the Client's everyday life including, but not limited to, community supports and relationships with family members, friends, co-workers, neighbors and acquaintances.

19. PERFORMANCE AND QUALITY REVIEW means a review conducted by the Department or its contractor at any time to include a review of required case management services performed by the CCB to ensure quality and compliance with all statutory and regulatory requirements.

20. PLAN YEAR mean a twelve (12) month period starting from the date when State-SLS Supports and Services where authorized.

21. PRIOR AUTHORIZATION means approval for an item or service that is obtained in advance either from the Department, a State fiscal agent.

22. PROGRAM APPROVED SERVICE AGENCY (PASA) means a developmental disabilities service agency or a service agency as defined in 8.602, that has received program approval, by the Department, to provide Medicaid Wavier services.

23. RELATIVE means a person related to the Client by virtue of blood, marriage, or adoption.

24. RETROSPECTIVE REVIEW means the Department's review after services and supports are provided and the PASA is reimbursed for the service, to ensure the Client received services according to the PCSP and standards of economy, efficiency and quality of service.

25. STATE-SLS INDIVIDUAL SUPPORT PLAN means the written document that identifies an individual's need and specifies the State-SLS services being authorized, to assist a Client to remain safely in the community.

26. STATE FISCAL YEAR means a 12-month period beginning on July 1 of each year and ending June 30 of the following calendar year. If a single calendar year follows the term, then it means the State Fiscal Year ending in the calendar year.

27. Services and Supports or Supports and Services means one or more of the following: Education, training, independent or supported living assistance, therapies, identification of natural supports, and other activities provided to

a. To enable persons with intellectual and developmental disabilities to make responsible choices, exert greater control over their lives, experience presence and inclusion in their communities, develop their competencies and talents, maintain relationships, foster a sense of belonging, and experience person security and self-respect.

28. SUPPORT SERVICE means the service(s) established in the State SLS program that a CCB Case Manager may authorize to support an eligible Client to complete the identified tasks identified in the Client's Individualized Support Plan.

29. WAIVER SERVICE means optional services and supports defined in the current federally approved HCBS waiver documents and do not include Medicaid State Plan benefits.

8.501.2Administration:

1. The CCB shall administer the State-SLS program according to all applicable statutory, regulatory and contractual requirements, and Department policies and guidelines.

a. The CCB is responsible for providing case management to all individuals enrolled in the State-SLS program.

b. The CCB shall have written procedures related to the administration, case management, service provision, and waiting list for the State-SLS program.

c. All records must be maintained in accordance with section 8.130.2.

d. The CCB shall maintain a waiting list of eligible individuals for whom Department funding is unavailable in accordance with section 8.501.7.

e. The CCB shall develop procedures for determining how and which individuals on the waiting list will be enrolled into the State-SLS program that comply with all applicable statutory, regulatory and contractual requirements including section 8.501.7.

f. Any decision to modify, reduce or deny services or supports set forth in the State SLS program, without the Individual's or Guardian's agreement, are subject to the requirements in Section 8.605.

2. Eligibility

a. General Eligibility requirements

i. Individuals must be a resident of Colorado;

ii. Be eighteen (18) years of age or older; and

iii. Be determined to have an intellectual or developmental disability pursuant to the procedures set forth in section 8.607.2.

b. Eligibility for the State-SLS program does not guarantee the availability of services and supports under this program.

3. General Provisions

a. The availability of services offered through the State-SLS program may not be consistent throughout the State of Colorado or between CCBs.

b. An individual enrolled in the State-SLS program shall access all benefits available under the Medicaid State Plan, HCBS Waiver or EPSDT, if available, prior to accessing services under the State-SLS program. Services through the State-SLS program may not duplicate services provided through the State Plan when available to the Client.

c. Evidence of attempts to utilize all other public benefits and available and accessible community resources must be documented in the State-SLS individualized Support Plan by the CCB Case Manager, prior to accessing State-SLS services or funds.

d. The State-SLS program shall be subject to annual appropriations by the Colorado General Assembly.

e. These regulations shall not be construed to prohibit or limit services and supports available to persons with intellectual and developmental disabilities that are authorized by other state or federal laws.

f. When an individual is enrolled only in the State-SLS program the CCB Case Manager shall authorize a Program Approved Service Agency (PASA) to deliver the services, when available.

g. When a PASA is not available the CCB Case Manager may authorize and provide the Support Service, through the State-SLS program, to assist the Client with tasks identified in his or her Individual Support Plan.

h. The CCB Case Manager may authorize Services and Supports from multiple State-SLS service categories at once, unless otherwise stated.

i. Unless otherwise specified, State-SLS Services and Supports may be utilized in combination with other Community Resources and/or Medicaid Services and Supports, as long as they are not duplicative, and all other available and accessible resources are utilized first.

4. Performance and Quality Review

a. The Department shall conduct a Performance and Quality Review of the State-SLS program to ensure that the CCB is in compliance with all statutory and regulatory requirements.

b. A CCB found to be out of compliance shall be required to develop a Corrective Action Plan, upon written notification from the Department. A Corrective Action Plan must be submitted to the Department within ten (10) business days of the date of the written request from the Department. A Corrective Action Plan shall include, but not limited to:

i. A detailed description of the actions to be taken to remedy the deficiencies noted on the Performance and Quality Review, including any supporting documentation;

ii. A detailed time-frame for completing the actions to be taken;

iii. The employee(s) responsible for implementing the actions; and

iv. The estimated date of completion.

c. The CCB shall notify the Department in writing, within three (3) business days if it will not be able to present the Corrective Action Plan by the due date. The CCB shall explain the reason for the delay and the Department may grant an extension, in writing, of the deadline for the submission of the Corrective Action Plan.

i. Upon receipt of the proposed Corrective Action Plan, the Department will notify the CCB in writing whether the Corrective Action Plan has been accepted, modified, or rejected.

ii. In the event that the Corrective Action Plan is rejected, the CCB shall re- write the Corrective Action Plan and resubmit along with the requested documentation to the Department for review within five (5) business days.

iii. The CCB shall begin implementing the Corrective Action Plan upon acceptance by the Department.

iv. If the Corrective Action Plan is not implemented within the timeframe specified therein, funds may be withheld or suspended.

8.501.3CCB and PASA Reimbursement

1. A PASA must submit all claims, payment requests, and/or invoices to the CCB for payment within thirty (30) days of the date of service, except for Services and Supports rendered in June, the last month of the State Fiscal Year. All claims, payment requests, and/or invoices for Services and Supports rendered in June must be submitted by the date specified by the CCB to ensure payment.

2. CCBs must submit all claims, payment requests, and/or invoices in the format and timeframe established by the Department.

3. CCB's and PASA's claims, payment requests, or invoices for reimbursement shall be made only when the following conditions are met:

a. Services and Supports are provided by a qualified PASA.

b. Services and Supports are authorized and delivered in accordance with the frequency, amount, scope and duration of the service as identified in the Client's State-SLS Individual Support Plan;

c. Required documentation of the specific service is maintained and sufficient to support that the service is delivered as identified in the State-SLS Individual Support Plan and in accordance with the service definition;

d. All case management activities must be documented and maintained by the CCB.

1. CCBs and PASAs shall maintain records in accordance with Section 8.130.2.

2. CCB and PASA reimbursement shall be subject to review by the Department and may be completed after the payment has been made to the CCB and PASA. CCBs and PASAs are subject to all program integrity requirements in accordance with section 8.076.

3. The reimbursement for this service shall be established in the Department's published fee schedule.

4. Except where otherwise noted, PASA reimbursement shall be based on a statewide fee schedule. State developed fee schedule rates are the same for both public and private PASAs and the fee schedule and any annual/periodic adjustments to the fee schedule are published in the PASA bulletin and can be accessed through the Department's fiscal agent's web site.

a. State-SLS rates shall be set and published in the provider bulletin annually each State Fiscal Year.

8.501.4State-SLS Covered Services and Supports

8.501.4.A.Supports for Individuals waiting for HCBS waiver enrollment.

1. Eligible Clients may receive the following Services and Supports

a. All Services and Supports identified in the HCBS-SLS waiver identified in section 8.500 .94

b. Service limitations in the HCBS-SLS waiver and set forth in section 8.500 apply to the State-SLS program.

c. When a PASA is not available to provide Supports and Services the CCB may authorize the Support Services, to provide the needed Supports and Services identified in the State-SLS Individual Support Plan.

8.501.4.BSupports for Individuals Experiencing Temporary Hardships

1. State-SLS may be utilized to provide the following temporary Supports and Services to Individuals who have been determined to meet the criteria for an Intellectual / Developmental Disability as specified in Section 8.607.2, in situations where temporary assistance can alleviate the need for a higher level of care. These Services and Supports cannot be duplicative and shall not be accessed if available through other sources. In order to access State-SLS, an Individual Support Plan must be completed.

a. Payment of utilities:

i. Paying gas/electric bills and/or water/sewer bills:

Documentation must be maintained by the CCB that all alternative programs, community support, and Natural Supports were utilized before any State-SLS funds were authorized.

b. Supports with acquiring emergency food, at a retail grocery store when there are no other community resources available

i. Documentation must be maintained by the CCB demonstrating the reason why State-SLS funds were utilized over other sources of emergency food. This may include but is not limited to:

1) Other emergency food programs are not available.

2) Home delivered meals have unexpectedly stopped.

c. Pest infestation abatement:

i. Documentation must be maintained by the Case Manager showing that infestation abatement is not covered under the Client's residential agreement or lease.

ii. Documentation that the pest abatement professional is licensed in the state of Colorado, must be maintained by the CCB and provided to the Department upon request.

iii. Pest infestation abatement shall not be authorized if the Client resides in a PASA owned and/or controlled property.

iv. Documentation showing proof of payment must be maintained by the CCB administering the State-SLS program;

2. Service Limitations

a. Support for utilities shall not exceed $1000.00 in a State Fiscal Year.

b. Support for pest infestation abatement shall not exceed $2000.00 in a State Fiscal Year;

i. Supports for pest infestation abatement shall not cover more than one infestation event in a State Fiscal Year; and

ii. Multiple treatments per event may be authorized, if determined necessary by a licensed pest abatement professional.

iii. Emergency food support shall not exceed $400.00 in a State Fiscal Year.

8.501.4.CSupporting Independence in the Community.

1. State-SLS may be utilized to provide an individual found eligible for or enrolled in an HCBS Medicaid waiver, with a one-time payment or acquisition of needed household items, in the event the Client is moving into a residence as defined in Section 8.500.93.A.(7).

a. State-SLS funds may be utilized for payment or acquisition of

i. initial housing costs including but not limited to a one-time initial set up for pantry items and/or kitchen supplies and/or furniture purchase.

b. Individuals enrolled in the HCBS-DD waiver residing in an Alternative Care Facility (ACF), Group Residential Supports and Services (GRSS) or Individual Residential Supports and Services - Host Home (IRSS-HH) setting are not eligible for this Support.

2. State-SLS funds may support someone to have greater independence when they are moving into their own home, by paying for housing application fee.

3. The CCB shall maintain receipts or paid invoices for purchases authorized in this section. Receipts or paid invoices must contain at a minimum, the following information: business name, item(s) purchased, item(s) cost, date paid, and description of items purchased. Documentation must be made available to the Department upon request. All items must be purchased from an established retailer that has a valid business license.

4. Service limitations

a. The one-time furniture purchase shall not exceed $300.00.

b. The one-time initial pantry set up shall not to exceed $100.00.

c. The one-time purchase of kitchen supplies shall not to exceed $200.00.

d. The payment of housing application fees are limited to five (5) in a State Fiscal Year.

8.501.4.DOn-going State-SLS Support.

1. State-SLS funds may be authorized by the CCB for individuals who have been determined to meet the DD Determination requirements, but do not meet the requirements to be enrolled in HCBS-SLS Waiver section 8.500.93.

a. An eligible Client may be authorized to receive any service set forth in the HCBS-SLS waiver regulation at section 8.500.90.

b. Service limitation and service rules found in the HCBS-SLS waiver regulation at section 8.500.90 applies to the State SLS program.

c. A Program Approved Service Agency (PASA) is authorized to provide State-SLS services; and

2. When an individual is enrolled in an HCBS waiver, other than the HCBS-DD or HCBS-SLS waiver and needed Supports and Services not provided by that waiver, the CCB may authorize State-SLS funds.

a. A comparable service must not be available in the enrolled waiver.

b. State-SLS funds may not be utilized for Home Accessible Adaptation, or Vehicle Modification.

c. Only a PASA shall provide these services.

3. Service Limitation

a. Total authorization limit for the plan year shall be determined by the Departments and be communicated annually on the State-SLS Program rate schedule.

8.501.4.EState-SLS Individual Support Plan.

1. State-SLS Clients are required to have a State SLS Individual Support Plan that is signed and authorized by the CCB Case Manager and the Client, or their Guardian.

2. The State-SLS Individual Support Plan shall be developed through an in-person face to face meeting that includes at least, the individual seeking services and the CCB Case Manager. Upon Department approval, contact may be completed by the case manager at an alternate location, via the telephone or using virtual technology methods. Such approval may be granted for situations in which face-to-face meetings would pose a documented safety risk to the case manager or Client (e.g. natural disaster, pandemic, etc.

3. If a Client seeks additional supports or alleges a change in need, the State-SLS Individual Support Plan shall be reviewed and updated by the CCB Case Manager prior to any change in authorized services and supports.

4. The State-SLS Individual Support Plan shall be effective for no more than one year and reviewed at least every 6 months, in a face-to-face meeting with the Client or on a more frequent basis if a change in need occurs. Upon Department approval, contact may be completed by the case manager at an alternate location, via the telephone or using virtual technology methods. Such approval may be granted for situations in which face-to-face meetings would pose a documented safety risk to the case manager or Client (e.g. natural disaster, pandemic, etc.

a. Any changes to the provision of the services and supports identified in the State-SLS Individual Support Plan are subject to available funds within the designated service area.

b. Any decision to modify, reduce or deny services and supports set forth in the State-SLS Individual Support Plan, without the Client's consent is subject to the Dispute Resolution Process found in section 8.605.2.

5. The State-SLS Individual Support Plan and all supporting documentation will be maintained by the case manager and will be made available to the Department upon request.

6. The State-SLS Individual Support Plan shall include the following;

a. The Supports and Services authorized, the Client's identified needs and how the Supports and Service will address the needs.

b. The scope, frequency, and duration of each service.

c. Documentation demonstrating if other public or community resources have been utilized and why State-SLS funds are being utilized instead of or in combination with other resources.

d. Total cost of the supports being authorized.

e. Information to support authorization of services under Supports for Individuals Experiencing Temporary Hardships, including:

i. A description of the hardship.

ii. The reason for the hardship.

iii. The length of time the support will be authorized, including the date of the onset of the hardship and the date it is expected to end.

iv. Total amount needed to support the individual and what other community resources are contributing.

v. A plan to reasonably ensure the hardship is temporary.

vi. A plan to reasonably ensure that dependence on State-SLS funds will be temporary.

vii. The dates of when the long-term solution will be in place and when the temporary hardship is expected to end.

viii. Documentation demonstrating how utilizing State-SLS funds will lead to the Client gaining more independence in the community or maintaining their independence in the community.

f. Additional Information required for authorization of services for the purpose of Supporting Independence in the Community:

i. Total amount needed to support the individual and what other community resources are contributing.

g. Additional Information to be included for authorization of services On-going State -SLS Supports;

i. Documentation demonstrating why the individual enrolled in State-SLS is not eligible or enrolled in a HCBS Medicaid waiver or documentation showing which HCBS waiver the individual is enrolled in; and

ii. Documentation demonstrating how authorized services are not duplicative or comparable to others the individual is eligible for or has access to.

8.501.5Case Management Services

8.502.5.AAdministration

1. CMAs shall comply with all requirements set forth in section 8.607.1.

8.501.5.BCase Management Duties:

1. The case manager shall coordinate, authorize and monitor services based on the approved State-SLS Individual Support Plan.

a. The case manager shall have, based on the Client's preference, a face to face or telephone contact once per quarter with the Client.

2. The CCB Case Manager shall assist Clients to gain access to other resources for which they are eligible and to ensure Clients secure long-term support as efficiently as possible.

3. The CCB Case Manager shall provide all State-SLS documentation upon the request from the Department.

4. Referrals to the State-SLS program shall be made through the CCB in the geographic catchment area the Client or Applicant resides in.

8.501.6Transferring Services Between Community Centered Boards:

1. When an individual enrolled in, or on the waiting list for, the State-SLS program moves to another CCB's catchment area, and wishes to transfer their State-SLS, the following procedure shall be followed:

a. The originating CCB will contact the receiving CCB to inform them of the individual's desire to transfer.

b. The originating CCB will send the State-SLS Individual Support Plan to the receiving CCB, where the receiving CCB will determine if appropriate State-SLS funding is available or if the individual will need to be placed on a waiting list. The receiving CCB's decision of service availability will be communicated in the following way:

i. The receiving CCB will notify the individual seeking transfer of its decision by the individual's preferred method, no later than ten (10) business days from the date of the request; and

ii. The receiving CCB will notify the originating CCB of its decision by U.S. Mail, phone call or email of its decision no later than ten (10) business days from the date of the request.

c. The decision shall clearly state the outcome of the decision including:

i. The basis of the decision; and

ii. The contact information of the assigned Case Manager or waiting list manager.

d. The originating CCB shall contact the individual requesting the transfer no more than 5 days from the date the decision was received to:

i. Ensure the individual understands the decision; and

ii. Support the individual in making a final decision about the transfer.

e. If the transfer is approved, there shall be a transfer meeting in-person when possible, or by phone if geographic location or time does not permit, within in fifteen (15) business days of when the notification of service determination is sent out by the receiving CCB. The transfer meeting must include but is not limited to the transferring individual and the receiving case manager. Any additional attendees must be approved by the transferring individual.

f. The receiving CCB must ensure that:

i. the transferring individual meets his or her primary contact of the receiving CCB.

ii. The individual is informed of the date when Services and Supports will be transferred, when Services and Supports will be available, and the length of time the Supports and Services will be available.

g. The receiving CCB case manager shall have an in-person face to face meeting with the Client to review and update the State-SLS Individual Support Plan, prior to the Supports and Services being authorized. Upon Department approval, contact may be completed by the case manager at an alternate location, via the telephone or using virtual technology methods. Such approval may be granted for situations in which face-to-face meetings would pose a documented safety risk to the case manager or Client (e.g. natural disaster, pandemic, etc.).

8.501.7WAITING LIST PROTOCOL

1. Persons determined eligible to receive services under the State SLS program, shall be eligible for placement on a waiting list for services when state funding is unavailable.

2. Waiting lists for persons eligible for the State SLS program shall be administered by the Community Centered Boards, uniformly administered throughout the State and in accordance with these rules and the Operating Agency's procedures.

3. Persons determined eligible shall be placed on the waiting list for services in the Community Centered Board service area of residency.

a. The date used to establish a person's placement on a waiting list shall be:

i. The date on which an individual is determined eligible for the State SLS program through the DD Determination and the identification of need.

4. As funding becomes available in the State SLS program in a designated service area, persons shall be considered for services in order of placement on the local Community Centered Board's waiting list.

5. Individuals with no other State or Medicaid funded services or supports will be given priority for enrollment including individuals who lose Medicaid eligibility and lose Medicaid Waiver services.

6. Exceptions to these requirements shall be limited to:

a. Emergency situations where the health, safety, and welfare of the person or others is greatly endangered, and the emergency cannot be resolved in another way. Emergencies are defined as follows:

i. Homeless: the person will imminently lose their housing as evidenced by an eviction notice; or whose primary residence during the night is a public or private facility that provides temporary living accommodations; or any other unstable or non-permanent situation; or is discharging from prison or jail; or is in the hospital and does not have a stable housing situation to go upon discharge.

ii. Abusive or Neglectful Situation: the person is experiencing ongoing physical, sexual, or emotional abuse or neglect in his/her present living situation and his/her health, safety or well-being are in serious jeopardy.

iii. Danger to Others: the person's behavior or psychiatric condition is such that others in the home are at risk of being hurt by him/her. Sufficient supervision cannot be provided by the current caretaker to ensure the safety of persons in the community.

iv. Danger to Self: a person's medical, psychiatric or behavioral challenges are such that s/he is seriously injuring/harming himself/herself or is in imminent danger of doing so.

v. Loss or Incapacitation of Primary Caregiver: a person's primary caregiver is no longer in the person's primary residence to provide care; or the primary caregiver is experiencing a chronic, long-term, or life-threatening physical or psychiatric condition that significantly limits the ability to provide care; or the primary caregiver is age 65 years or older and continuing to provide care poses an imminent risk to the health and welfare of the person or primary caregiver; or, regardless of age and based on the recommendation of a professional, the primary caregiver cannot provide sufficient supervision to ensure the person's health and welfare.

7. Documentation demonstrating how the individual meets the emergency criteria shall be kept on file at the CCB and made available to the Department upon request.

10 CCR 2505-10-8.501

46 CR 13, July 10, 2023, effective 7/30/2023

47 CR 16, August 25, 2024, effective 9/14/2024