10 Colo. Code Regs. § 2505-10-8.609

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

Section 10 CCR 2505-10-8.609 - [Repealed effective 9/14/2024] PROGRAM SERVICES AND SUPPORTS

8.609.1SUPPORT SERVICES

Support services include supported living services for adults 18 years and older and the children's extensive support program for children through age 17.

A. Supported Living Services for adults are intended to provide the necessary assistance and support to meet the daily living and safety needs of persons who are responsible for their own living arrangements in the community. Services are intended to augment available supports for those individuals who can live independently with limited supports, or who, if they need extensive support, are getting that support from other sources.

B. Children's extensive support services are intended to provide the services and supports to children most in need because of the severity of the disability and provide for stability of the family setting which would allow the child to continue to remain in the family home.

C. Medicaid funded supported living services for adults and children's extensive support services are provided through the home and community based services program which is described in Section 8.500.

8.609.2SUPPORT SERVICES GENERAL PROVISIONS

A. Services and supports shall be provided pursuant to the person's Individualized Plan and Individual Service and Support Plans, as appropriate.

Individual Service and Support Plans shall be developed, as needed, to ensure that services and supports are provided consistently and reach the intended results, as determined by the Interdisciplinary Team.

B. Services and supports provided shall be in accordance with the Department's rules.

C. Each support coordinating agency shall be responsible to ensure there is no interruption of services and supports that are critical to a person's health and safety and which if not delivered could result in imminent harm to the person.

D. Individuals, parents of a minor or guardians shall have the opportunity to choose and direct services necessary to meet their identified and prioritized needs and to choose among qualified service providers. Provision of services by family members, as defined in Section 25.5-10-202(16), C.R.S., living in the same household (under the same roof and same physical address) with the program participant shall be on an exception basis only and in accordance with the requirements of the applicable Medicaid waiver.

E. Each support coordinating agency shall establish and implement written procedures for:

1. The assignment of resources as prescribed by the Department; and,

2. Approving expenditures for adaptations and devices as prescribed by the Department.

F. For persons receiving services who are assisted in the administration of medications by a person other than a relative, the following is required:

1. A written record of medications, including time and the amount of medication, taken by the person;

2. Written orders by a licensed physician or dentist for all medications;

3. Documentation of the effects of psychotropic medications and any changes in medication; and,

4. The use of medication reminder boxes pursuant to Section 25-1.5-303(1) C.R.S.

G. The support coordinating agency shall provide for the regular monitoring of the health, safety and welfare of persons and the services and supports provided.

H. The support coordinating agency shall conduct an evaluation of consumer satisfaction no less than every three (3) years. The evaluation shall, at a minimum, include satisfaction with choice of services and providers.

I. The support coordinating agency shall maintain a record for each person receiving services which includes the information required by these rules and as prescribed by the Department.

Staff, providers and other support personnel shall have ready access to records and information required by them to carry out their responsibilities.

8.609.3CHILDREN'S EXTENSIVE SUPPORT PROGRAM

A. The child participating in the Children's Extensive Support Program shall live at home with his/her biological, adoptive parent(s) or guardian, or be in an out of home placement and being returned home with the provision of the program.

B. There shall be a record that the child's physician has certified that the medical services and supports identified in the Individualized Plan are sufficient to meet the child's needs in the home setting.

8.609.4COMPREHENSIVE HABILITATION SERVICES AND SUPPORTS

Medicaid funded Comprehensive Habilitation Services and Supports are provided through the Home and Community Based Services program which is described in the Colorado Department of Health Care Policy and Financing rules and regulations, Medical Assistance staff manual, section 8.500 (10 C.C.R. 2505-10) and the Department's program descriptions. State funded Comprehensive Habilitation Services and Supports are provided pursuant to the Department's program description. Comprehensive Habilitation Services and Supports specifically for individuals with developmental disabilities include:

A. Residential Habilitation Services and Supports

1. Individual Residential Services and Supports

2. Group Residential Services and Supports

B. Day Habilitation Services and Supports

1. Integrated employment services

2. Integrated activities services

3. Prevocational services

4. Other activities services

C. Transportation Acquisition Services

8.609.5RESIDENTIAL HABILITATION SERVICES AND SUPPORTS DESCRIPTION AND GENERAL PROVISIONS

Residential Habilitation Services and Supports provide a full day (24 hours) of services and supports to ensure the health, safety and welfare of the individual, and to provide training and habilitation services or a combination of training (i.e., instruction, skill acquisition) and supports in the areas of personal, physical, mental and social development and to promote interdependence, self-sufficiency and community inclusion. Services and supports are designed to meet the unique needs of each person determined by the assessed needs, personal goals, and other input provided by the Interdisciplinary Team, defined at Section 8.519.1, and to provide access to and participation in typical activities and functions of community life.

A. Program Approved Service Agency Policies, Procedures and Service Provisions

1. Each Program Approved Service Agency (PASA) providing residential services must establish and implement written policies and procedures concerning the use, handling and timely disbursement of personal needs funds and include a record of personal possessions, including clothing, of the participant.

2. PASAs must conduct an evaluation of consumer satisfaction with services and supports no less than every two years. The PASA must review and analyze this data and address any complaints or problematic practices requiring corrective action. PASAs must make the results of the survey available to interested stakeholders upon request.

3. The PASA must maintain a record for each participant which includes the information required by these rules and as prescribed by the Department.

4. Participants receiving Residential Habilitation Services and Supports must have 24-hour supervision. Supervision may be on-site (direct service provider or caregiver is present) or accessible (direct service provider or caregiver is not on site but available to respond when needed). Staffing arrangements must be adequate to meet the health, safety and welfare of participants and the needs of the individual as determined by the Service Plan. The PASA is responsible for verifying that any direct care provider they employ or contract with has the capacity to serve the individuals in their care, as outlined in the Support Plan.

5. Physical facilities utilized as residential settings must meet all applicable fire, building, licensing and health regulations.

6. Services and supports must be provided pursuant to the person's Service Plan, in accordance with Department guidelines and service descriptions, and the HCBS Settings Final Rule at 79 Fed. Reg. 2948 (Jan. 16, 2014) (codified in relevant part at 42 C.F.R. § 441.301).

7. The PASA is responsible for providing services, supplies and equipment as prescribed by the Department.

8. Caregivers, providers and other support personnel must have ready access to records and all necessary, detailed protocols about the participant required to carry out their responsibilities.

9. PASAs must comply with the Colorado Adult Protection Services (CAPS) requirements, outlined in § 26-3.1-111, C.R.S. and 12 CCR 2518-1, Volume 30.960. The PASA must maintain accurate records and make records available to the Department upon request.

a. Direct service provider means any person providing direct services and supports, including case management services, protective services, physical care, mental health services, or any other service necessary for the at-risk adult's health, safety, or welfare, pursuant to C.R.S. 26-3.1-101 (3.5). Direct service provider includes PASA applicants and owners, as they are ultimately responsible for the members they serve.

b. During the enrollment process the PASA may be granted provisional approval to render Medicaid services. Final PASA approval is contingent on submission of documentation of a completed CAPS check on the PASA applicant and owner within 90 days from the receipt of the provisional approval.

i. Failure to submit the required documentation within 90 days of the provisional approval period may result in rescindment of the provisional approval.

ii. For the purposes of C.R.S. 26-3.1-111(6)(a)(III), the Department of Health Care Policy and Financing is the oversight agency for PASAs and must be informed of CAPS check results for employers who run them on themselves.

c. Direct Service and backup providers with any of the following are prohibited from providing IRSS to any participant :

i. A substantiated allegation of abuse, neglect, exploitation, or harmful act, as defined in Section 26-3.1-101, C.R.S., within the last 10 years, by APS at a severity level of "Moderate" or "Severe" as defined in 12 CCR 2518-1 Section 30.100;

ii. Three or more substantiated allegations of abuse, neglect, exploitation, or harmful act, as defined in Section 26-3.1-101, C.R.S., within the last five years, by APS at the minor severity level as defined in 12 CCR 2518 Section 30.100; or

iii. A criminal conviction of abuse, neglect, or exploitation against an at-risk adult with IDD as defined in Section 18-6.5-102, C.R.S.

iv. Only substantiated allegations that have exhausted the appeal period and come to a final disposition, as defined as 12 CCR 2518-1 Section 30.920, shall be included in the above exclusions list.

10. Incident Reporting

a. The PASA must comply with all incident reporting requirements, as outlined in Section 8.608.6.

b. The PASA must notify guardians and/or representatives of Incident Reports (IR).

c. The PASA must have policies and procedures in place for handling cases of alleged or suspected abuse, mistreatment, neglect, or exploitation of any participant, pursuant to Section 8.608.8.

d. The PASA must notify the waiver participant and guardians and/or participants' representatives of investigations, including summary information pertaining to the outcome of the investigation, victim supports accessed, and recommendations to prevent recurrence.

11. The PASA is responsible for the monitoring of conditions at the property and must provide oversight and guidance to safeguard the health, safety, and welfare of the participant.

12. The PASA must provide for and document the regular on-site monitoring of Residential Habilitation Services and Supports. PASA's must conduct an on-site visit of each Individual Residential Support Services (IRSS) or Group Residential Support Services (GRSS) setting before a participant moves in, and at a minimum once every quarter, with at least one visit annually that is unscheduled. On-site monitoring of IRSS and GRSS settings must include, but not be limited to:

a. Inspection of all smoke alarms and carbon monoxide detectors;

b. Ensuring all exits are free from blockages to egress;

c. Review of each participant's emergency and disaster assessment; and

d. Medication administration records and physician orders.

B. Rights of Participants

1. A participant must be presumed able to manage his/her own funds and possessions unless otherwise documented in the Service Plan.

2. Participants must have a key or key code to their home, a bedroom door with a lock, lockable bathroom doors, access to all common areas of the home, and a residential agreement that provides protections for evictions.

3. A participant, guardians, authorized representatives, as appropriate, and the case manager shall be notified at least fifteen (15) days prior to proposed changes in residential placements.

a. If an immediate move is required for the protection of the person, notification must occur as soon as possible before the move or no later than three days after the move.

b. A participant, guardians, and authorized representatives, as appropriate, must be involved in planning subsequent placements and any member of the Interdisciplinary Team may request a meeting to discuss the change in placement.

c. When a participant moves settings or PASA, all residential PASA's involved must be present for the move whenever possible, and will ensure all possessions, medications, money and pertinent records are transferred to the participant within 24 hours.

d. If the participant, guardians, or authorized representative, as appropriate, wants to contest the move they should follow the grievance procedure of the agency.

e. If there is a concern regarding the health, safety, or welfare of the person being jeopardized as a result of the move, any interested party may request an emergency order from the Department pursuant to Section 8.605.4.

4. Participants have a right to annual notification of PASA appeal/grievance policies and procedures.

8.609.6COMPREHENSIVE HABILITATION SERVICES AND SUPPORTS MEDICAL, THERAPY, AND MEDICATION PROVISIONS

A. Persons receiving comprehensive services and supports shall be assured of medical and dental services necessary to maintain the health of the person and to prevent further disability and shall have dentures, eyeglasses, hearing aids, braces and other aids or therapies as prescribed by an appropriate professional.

B. Each program approved service agency shall have provisions for emergency medical care and procedures to be followed in rendering emergency medical care.

C. Therapy assessments shall be completed as the need for these is identified by the interdisciplinary team and/or physician. Based on these assessments, therapies shall be provided to maintain the health of the person receiving services, to prevent further disability and, whenever possible, to improve the overall functioning of the person receiving services.

1. Therapy programs shall be periodically reviewed by a professional therapist from the relevant specialty area.

2. Persons receiving services who use wheelchairs and other assistive technology services shall receive professional reviews, at a prescribed or recommended frequency, to ascertain the continued applicability and fitness of those devices.

3. Wheelchairs and other assistive technology devices shall be maintained in good repair.

D. The program approved service agency shall provide sufficient supports to persons receiving services in the use of prescription and non-prescription medications to protect the health and safety of persons receiving services. Decisions concerning the type and level of supports provided shall be based on the abilities and needs of the person receiving services as determined by assessment and shall be in compliance with these rules.

1. Each program approved service agency shall establish and implement written procedures for the appropriate procurement, storage, distribution and disposal of medications.

a. All drugs shall be stored under proper conditions of temperature, light, and with regard for safety.

b. Discontinued drugs, outdated drugs, and drug containers with worn, illegible, or missing labels shall be promptly disposed of in a safe manner.

c. A record shall be maintained of missing, destroyed or contaminated medications.

d. The use of medication reminder boxes shall be pursuant to section 25-1.5-303(1) C.R.S.

2. No prescription medication shall be administered without a written order by a licensed physician or dentist.

3. The drug regimen of each person receiving services on prescription medication shall be reviewed and evaluated by a licensed physician no less often than annually and more frequently if recommended by the physician or required by law.

4. Refusals to take medications by a person receiving services and drug reactions shall be recorded. On-going refusals to take medications shall be addressed by the person's physician.

5. For persons receiving services who are not independent in the administration of their own medications the following shall be required:

a. A written record of medications, including time and the amount of medication, taken by the person receiving services; and,

b. Physician orders for over the counter medications.

6. For persons receiving services who are independent in the administration of medications and who do not require monitoring each time medication is taken, the program approved service agency shall provide sufficient, at minimum quarterly, monitoring or review of medications to determine that medications are taken correctly.

7. Psychotropic medication for persons receiving residential services and supports shall be used only for diagnosed psychiatric disorders and:

a. When a specific psychiatric evaluation or consultation has resulted in the recommendation for use of medication;

b. When the person's Individualized Plan specifies the use of psychotropic medication;

c. After informed consent of the person receiving services, the parent of a minor, or the legal guardian of an adult has been obtained or pursuant to a valid court order;

d. After completion of a comprehensive review of the person's life situation and an Individual Service and Support Plan. The Individual Service and Support Plan shall explain the specific methodologies, strategies or procedures that will be implemented to assist the person to maintain stability or that will be implemented in a crisis; and,

e. When reviewed by the Human Rights Committee.

8. Administration of psychotropic medications to a person receiving residential services and supports shall:

a. Be authorized through a time-limited prescription of no more than ninety (90) days by a fully licensed physician and reviewed at least annually by a psychiatrist;

b. Be in the minimum effective dose possible;

c. Allow for gradual reduction of the dosage and ultimate discontinuation of the drug, unless clinical data establishes the presence of a psychiatric condition requiring that a maintenance level of the drug be administered;

d. Ensure employees and contractors are knowledgeable of potential side effects and adverse reactions to the drugs;

e. Include regular monitoring of the person receiving services for potentially irreversible side effects such as tardive dyskinesia and other abnormal movements and effects, neurotoxicity, and neuroleptic malignant syndrome;

f. Include documentation of the effects of medications and any changes in medication; and,

g. Not be ordered on a PRN or "as needed" basis.

8.609.7INDIVIDUAL RESIDENTIAL SERVICES AND SUPPORTS (IRSS) SPECIFICATIONS

A. Individual Residential Services and Supports (IRSS) use a variety of living arrangements to meet the unique needs for support, guidance and habilitation of each participant.

1. IRSS settings include, but are not limited to:

a. a home owned, leased or controlled by the Program Approved Service Agency (PASA);

b. a home of a family member;

c. their own home; or

d. a Host Home.

i. The Host Home is the primary residence of the provider, which means that the Host Home provider occupies the residence seventy-five (75) percent of the time. The Host Home provider may not contract to provide services to more than three (3) individuals, inside or outside of the Host Home, at any given time.

B. Program Approved Service Agency Policies, Procedures and Service Provisions

1. The PASA has the responsibility for the living environment, regardless of the setting type.

2. IRSS may be provided to no more than three participants in a single setting. For each participant in a setting, the PASA must ensure the following criteria are met and documented:

a. The participants involved elect to live in the setting;

b. Each participant must have their own bedroom, unless they elect to share a bedroom with a roommate of their choice, which must be documented in the Service Plan;

c. Back-up providers are identified, available and agreed upon by the participant and PASA. When a back-up provider is not available, the PASA assumes responsibility for identifying a provider;

d. The PASA and case management agency of each participant in the setting must be involved in the coordination of placement of each participant;

e. Participants are afforded regular opportunities for community inclusion of their choice;

f. Participants are afforded individual choice, including preference to live near family;

g. Distance from other homes (e.g., apartments, houses) of participants is examined so that persons with developmental disabilities are not grouped in a conspicuous manner;

h. For the placement of an individual into a three-person setting, the following factors must be examined to determine reasonableness of the placement:

i. Level of care and needs of each participant in the home;

ii. Availability to support and provide supervision to participants;

iii. Compliance with HCBS Settings Final Rule at 79 Fed. Reg. 2948 (Jan. 16, 2014) (codified in relevant part at 42 C.F.R. § 441.301); and

iv. Each participant's ability to evacuate.

i. When three participants reside in a single setting, the PASA must conduct monthly monitoring of the setting.

3. Participants must live safely in environments common to other citizens with reasonable and appropriate supports provided to protect their health and safety while simultaneously promoting community inclusion. Providers and caregivers must have the appropriate knowledge, skills, and training to meet the individual needs of the participant before providing care and services. The PASA must have policies and procedures in place outlining the required trainings for providers and caregivers. The policy and procedure shall include, but not be limited to, the following:

a. Training specific to the participants' needs shall be completed by all providers and caregivers. Such training shall include, at a minimum, medical protocols and activities of daily living needs.

b. Providers and caregivers shall receive training in resident rights, abuse and neglect prevention, and reporting abuse, neglect, mistreatment and exploitation.

4. Upon enrollment in services, the PASA must assess each participant's ability to care for their safety needs and take appropriate action in case of an emergency. The assessment must be kept up to date and, at a minimum, address the following emergencies and disasters:

a. Fire;

b. Severe weather and other natural disasters;

c. Serious accidents and illness;

d. Assaults; and,

e. Intruders.

5. There must be a written plan for each person addressing how the emergencies specified above will be handled. The plans must be based on an assessment, maintained current and shall, at minimum, address:

a. Specific responsibilities/actions to be taken by the participant, approved caregivers or other providers of supports and services in case of an emergency;

b. How the participant will evacuate in case of fire by specifying, at minimum, two exit routes from floors used for sleeping and the level of assistance needed; and

c. Telephone access (by the participant or with assistance) to the nearest poison control center, police, fire and medical services.

6. Safety plans and evacuation procedures must be reviewed and practiced at sufficient frequency and varying times of the day, but no less than once a quarter, to ensure all persons with responsibilities for carrying out the plan are knowledgeable about the plan and capable of performing it. All safety plans must be on site at the home and be reviewed by the PASA agency during each on-site monitoring visit.

7. The PASA must provide sufficient oversight and guidance and have established procedures to ensure that the health and medical needs of the participant are addressed. This includes:

a. Each participant must have a primary physician;

b. Each participant must receive a medical evaluation at least annually unless a greater or lesser frequency is specified by his/her primary physician. If the physician specifies an annual evaluation is not needed, a medical evaluation must be conducted no less frequently than every two years;

c. Each participant must be encouraged and assisted in getting a dental evaluation annually;

d. Other medical and dental assessments and services must be completed as the need for these is identified by the physician, dentist, other medical support personnel or the Interdisciplinary Team; and

e. Records must contain documentation of:

i. medical services provided;

ii. results of medical evaluations/ assessments and of follow-up services required, if any;

iii. acute illness and chronic medical problems; and,

iv. weight taken annually or more frequently, as needed.

8. The PASA must have a written contract with each direct service provider that is not directly employed by the PASA and is providing IRSS under the PASA's authority, regardless of the setting type. This includes but is not limited to Host Home providers and family caregivers not directly employed by the PASA.

a. A current list of the above-mentioned contracted IRSS providers and their accompanying contracts must be on file with the program approved service agency and a copy must be provided to the Department or its agent upon request.

b. Each contract must be in writing and contain the following information:

i. Name of contracted IRSS provider;

ii. Responsibilities of each party to the contract, including, but not limited to, responsibility for the safety and accessibility of the physical environment of the home;

iii. An agreement outlining the living arrangements, monitoring of the Host Home, Host Home provider's duties, and any limitations on the Host Home providers duties;

iv. Expectations that participants be provided opportunities for informed choice over a variety of daily choices similar to those exercised by non-participants;

v. Process for correcting non-compliance;

vi. Process for termination of the contract;

vii. Process for modification or revision of the contract;

viii. Process for relocation of the participant if they are in immediate jeopardy of actual or potential for serious injury or harm;

ix. Process for coordinating the care of the participant;

x. Payment rate and method;

xi. Beginning and ending dates; and

xii. A clause that states the contracted IRSS provider shall not sub-contract with any entity to perform in whole the work or services required under the IRSS benefit.

c. PASAs who utilizes the services of subcontractors are responsible for the following, which includes but is not limited to:

i. Vetting, training, monitoring, and taking corrective action with employees and subcontractors.

ii. Nothing in these regulations shall create any contractual relationship between any subcontractor of the PASA and the Department.

d. If a contract is terminated with a contracted IRSS provider due to health, safety or welfare concerns, the PASA must report to the following parties:

i. Within 4 days to the Department or its agent regarding the cited reason for termination of a contracted IRSS provider.

ii. Within 4 days to the guardian or authorized representative and case manager of the participant from the terminated contracted IRSS provider.

9. The PASA must require each contracted direct service provider providing IRSS to document each approved caregiver(s) and report to the agency the names of all persons that reside in the home. Participants and/or guardians have a right to request and receive from the rendering PASA a list of all direct service and backup providers that are approved to provide them services. No backup provider may be hired without PASA approval. The agency must ensure criminal background checks are completed for any non-participant over the age of 18 who lives in the home.

10. The IRSS direct service provider is prohibited from conduct that would pose a risk to the health, safety and welfare of the member including the members mental health.

11. Each PASA must provide quarterly housing and participant updates to the Department or its agent through a specified data collection platform. Failure to provide these quarterly updates may result in payment suspension.

12. The PASA must ensure nutritionally balanced meals are available to participants. Based on an assessment of the person's capabilities, preferences and nutritional needs, the PASA may provide guidance and support to monitor nutritional adequacy.

a. Therapeutic diets must be prescribed by a licensed physician or dietician.

b. Participants must have access to food at all times, choose when and what to eat, the opportunity to provide input into menu planning, comfortable seating for meals where they can choose their own seat, and shall have access to food preparation areas as documented in the Service Plan.

C. Living Environment

1. Homes of participants must, at minimum, meet standards set forth in the Colorado Division of Housing (DOH) IRSS Inspection Protocol. The following setting types must pass the DOH IRSS Inspection Protocol every two years:

a. All Host Homes; and

b. All IRSS settings that are owned or leased by a PASA.

Settings must request an inspection prior to placement of a participant and must pass an inspection within 90 days of becoming an approved setting and providing services. Existing settings have until January 1, 2022 to pass an inspection.

2. The PASA must have a protocol in place for the emergency placement of the participant if a home is deemed not safe by the Division of Housing (DOH).

3. The home (exterior and interior) and grounds must:

a. Be maintained in good repair;

b. Protect the health, comfort and safety of the participant; and

c. Be free of offensive odors, accumulation of dirt, rubbish and dust.

4. There must be two means of exit from floors with rooms used for sleeping. Exits must remain clear and unobstructed.

5. The PASA must ensure entry to the home and an emergency exit is accessible to participants, including participants utilizing a wheelchair or other mobility device.

6. The PASA must ensure that participants who utilize a wheelchair or other mobility device have access to all common areas of the home

7. Bedrooms must meet minimum space requirements (single 80 square feet, double 120 square feet). (Not applicable for studio apartments.)

8. Adequate and comfortable furnishings and supplies must be provided and maintained in good condition.

9. Participants have the right to furnish and decorate their sleeping and/or living units in the way that suits them, while maintaining a safe and sanitary environment.

10. A fire extinguisher must be available in each home. Presence of an operational fire extinguisher shall be confirmed by the PASA during each on-site monitoring visit.

a. PASA's must follow manufacturer specifications and expiration dates for all fire extinguishers.

11. Smoke alarms and carbon monoxide detectors must be installed in the proper locations in each home to meet Housing and Urban Development (HUD) requirements and/or local ordinances. Smoke and carbon monoxide detectors shall be tested during each on-site monitoring visit by the PASA.

8.609.8GROUP RESIDENTIAL SERVICES AND SUPPORTS SPECIFICATIONS

A. Group Residential Services and Supports (GRSS) encompass group living environments of at least four and no more than eight persons receiving services.

B. A community residential home for individuals with developmental disabilities shall not be located within 750 feet of another such group home or within 750 feet of facility-based day programs or other program services operated for people with developmental disabilities unless previously approved by the Department.

C. Group Residential Services and Supports shall comply with the Colorado Department of Public Health and Environment Chapter VIII, Part 5 Rules and Regulations, in addition to these rules, and be licensed by the Colorado Department of Public Health and Environment.

D. No residential services and supports for individuals with developmental disabilities shall be recommended for licensure by the Colorado Department of Public Health and Environment, if required, unless approved by the Department.

E. The program approved service agency shall ensure a sufficient number of staff to meet licensing requirements and the needs of persons receiving services as determined by the Individualized Plan.

8.609.9DAY HABILITATION SERVICES AND SUPPORTS

A. Day Habilitation Services and Supports provide training, support and supervision activities which maximize functional abilities and skills necessary to enable adults to access the community and/or provide the basis for building skills which will assist individuals to access the community.

1. Day Habilitation Services and Supports are to be provided outside of the person's living environment, unless otherwise indicated by the person's needs, through meaningful employment, activities and community participation. If services cannot be provided outside of the living environment due to a person's medical or safety needs, this shall be documented.

2. Integrated employment should be considered as the primary option for all persons receiving Day Habilitation Services and Supports.

3. Day Habilitation Services and Supports include:

a. Integrated employment services (supported employment) which provide individuals with considerable ongoing job related services and supports to obtain and maintain paid work in a regular community work setting.

b. Integrated activities services which utilize the community as a learning environment to provide individuals access to, and participation in, typical activities and functions of community life. These services provide a variety of opportunities to facilitate relationships and natural supports in the community through activities such as volunteer work, community education or training and retirement activities.

c. Prevocational services which are provided in accordance with Section 8.500.5.B.2.e.

d. Other services engage individuals in a variety of functional activities which are primarily habilitative in nature with an emphasis on skill development and focus on generalizing those skills..

B. The physical facilities where day habilitation services are provided shall meet requirements for physical facilities pursuant to section 8.610.

C. Each program approved service agency shall have written plans to address emergencies regardless of service location or type of program.

10 CCR 2505-10-8.609

46 CR 03, February 10, 2022, effective 3/15/2023

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