10 Colo. Code Regs. § 2505-10-8.7506

Current through Register Vol. 47, No. 24, December 25, 2024

Section 10 CCR 2505-10-8.7506 - Alternative Care Facility

8.7506.AAlternative Care Facility Eligibility

1. Alternative Care Facility is a service available to Members enrolled in one of the following HCBS waivers:

a. Community Mental Health Services Waiver

b. Elderly, Blind, and Disabled Waiver

8.7506.BAlternative Care Facility Definitions

1. Alternative Care Facility authorized in § 25.5-6-303(3), C.R.S., means an Assisted Living Residence as defined at 6 C.C.R. 1011-1, Chapter VII, Section 2, which has been licensed by the Colorado Department of Public Health and Environment (CDPHE) and certified by the Department to provide Alternative Care Services to Medicaid Members.

a. Alternative Care Services as described in § 25.5-6-303(4), C.R.S., means a package of personal care and homemaker services provided in a state licensed and certified alternative care facility including, but not limited to: assistance with bathing, skin, hair, nail and mouth care, shaving, dressing, feeding, ambulation, transfers, positioning, bladder &bowel care, medication reminding and monitoring, accompanying, routine housecleaning, meal preparation, bed making, laundry, shopping, medication Administration, and Protective Oversight.

2. Protective Oversight means monitoring and guidance of a Member to assure their health, safety, and well-being. Protective Oversight also includes but is not limited to: monitoring the Member while on the premises of service setting, monitoring the Members' needs, and ensuring that the Member receives the services and care necessary to protect their health and welfare. Protective Oversight shall be no more intrusive than necessary to protect the health and welfare of the Member and others. If Protective Oversight for a Member entails Intensive Supervision as defined at Section 8.7001.A.6 or otherwise limits a Member's privacy, autonomy, access to the community, or other rights, then the Alternative Care Facility shall follow the Rights Modification process at Section 8.7001.B.4.

8.7506.CAlternative Care Facility Inclusions

1. Member Eligibility

a. Members enrolled in the HCBS Elderly, Blind and Disabled (EBD and the HCBS Community Mental Health Supports (CMHS) Waivers to are eligible to receive services in an Alternative Care Facility.

i. Potential Members shall be assessed, at a minimum, by a team that includes the Member and/or Guardian or other Legally Authorized Representative, the Alternative Care Facility administrator or appointed representative, and Case Management Agency Case Manager to determined that the Alternative Care Facility is an appropriate community setting that will meet the Member's choice and need for independence and community integration. If one of the parties listed above is not available, input or information must be obtained from each party prior to making an admission determination. The team may also include Family Members, Accountable Care Collaborative or Mental Health Center Case Managers, and any other interested parties as approved by the Member.

1) An assessment shall be conducted prior to admission, annually, whenever there is a significant change in physical, cognitive, or behavioral needs, or as requested by the Member. The annual assessment must be completed by the team described in Sections 8.7506.C.1.a.i.

2) The assessment shall document that the setting will support the Member and their needs. The assessment shall also document the Member's physical, behavioral and social needs, so that supports can be identified to enable them to lead as independent a life as possible. The assessment shall be used to develop the Member's care plan.

8.7506.DAlternative Care Facility Member Benefits

1. Alternative Care Services described at Section 8.7506.B.1.a are benefits to Members residing in an Alternative Care Facility .

a. When Medication Administration is provided as an Alternative Care Service reimbursement for Medication Administration is included in the reimbursement rate for Alternative Care Services and shall not be billed separately from Alternative Care Facility services.

2. Alternative Care Facility Provider Agencies shall not provide additional services which are available as a State Plan benefit or other HCBS-Community Mental Health Supports (CMHS) or HCBS-Elderly, Blind, and Disabled (EBD) waiver service.

3. Alternative Care Facility Provider Agencies shall provide Member engagement opportunities described in 6 C.C.R. 1011-1, Chapter VII, Part 13.1(C).

8.7506.EAlternative Care Facility Member Rights

1. Alternative Care Facility Provider Agencies shall inform Members of their rights, as set forth at 6 C.C.R. 1011-1, Chapter VII, Part 13 and Section 8.7001. Any modification of those rights shall be in accordance with Section 8.7001.B. Pursuant to 6 C.C.R. 1011-1, Chapter VII, Part 13.1, the policy on resident rights shall be in a visible location so that they are always available to Members and visitors.

2. Even if recommended by the Member's physician, staff interventions that interfere with the Member's choice of food, freedom to determine their own activities, or exercise of any other rights are Rights Modifications that may only be implemented following compliance with Section 8.7001.B.4.

3. Alternative Care Facility Provider Agencies shall inform Members of all Alternative Care Facility policies upon admission to the setting, and when changes to policies are made Rules and/or policies shall apply consistently to the administrator, staff, volunteers, and Members residing in the facility and their Family or friends who visit. Alternative Care Facility Provider Agencies shall document Member acknowledgement of rules and policies in a Provider Care Plan or a resident agreement.

4. If requested by the Member, the Alternative Care Facility shall provide bedroom furnishings, including but not limited to a bed, bed and bath linens, a lamp, a chair and a dresser and a way to secure personal possessions.

5. Alternative Care Facility Provider Agencies shall not discontinue services to a Member unless documented efforts have been ineffective to resolve the conflict leading to the discontinuance of services in accordance with 6 C.C.R. 1011-1, Ch. VII Section 11.

6. Alternative Care Facility Provider Agencies shall inform Members of the setting's policies and procedures for implementation of an individual's advance directives.

7. Alternative Care Facility Provider Agencies shall not require Medicaid Members to take part in performing household cleaning or maintenance tasks.

8.7506.FAlternative Care Facility Provider Agency Requirements

1. Alternative Care Facility Provider Agencies shall be licensed in accordance with 6 C.C.R. 1011-1, Chapters II and VII and obtain an Alternative Care Facility Certification prior to enrollment with the Department.

2. Member Engagement

a. In consultation with Members served, Alternative Care Facility Provider Agencies shall provide social and recreational engagement opportunities both within and outside the setting.

i. Opportunities for social and recreational engagement shall take into consideration the individual interests and wishes of the Members.

ii. In determining the types of opportunities and activities offered, the Provider Agencies shall consider the physical, social, and mental stimulation needs of the Members.

3. Member Leave

a. Alternative Care Facility Provider Agencies shall notify the Member's Case Manager of any Member planned or unplanned non-medical and/or programmatic leave of a duration greater than 24 hours.

b. The therapeutic and/or rehabilitative purpose of leave shall be documented in the Member's Provider Care Plan.

4. Provider Care Plan

a. The following information must be documented in the Member's Provider Care Plan:

i. Medical Information:

1) Medications the Member takes and how they are administered, with reference to the Medication Administration Record (MAR);

2) Special dietary needs, if any; and

3) Physician orders.

ii. Social and recreational engagement:

1) The Member's preferences and current relationships; and

2) Any recommended restrictions on social and/or recreational activities identified by a physician.

iii. Any other special health or behavioral management needs that support the Member's individual needs.

b. Additional Provider Care Plan Documentation:

i. Documentation from the admission process which demonstrates that the setting was selected by the Member;

ii. Identification of the Member's goals, choices, preferences, and needs and incorporation of these elements into the supports and services described in the Person-Centered Support Plan;

iii. Any modifications to the Member's rights, with the required supporting documentation; and

iv. Evidence the Member and/or their Guardian, or other Legally Authorized Representative has had the opportunity to participate in the development of the Provider Care Plan, as evidenced by the Member or other Legally Authorized Representatives' signature on the plan.

5. Environmental Standards

a. The Alternative Care Facility shall be an environment that supports individual comfort, independence, and preference, maintains a home-like quality and feel for Members at all times, and provides Members with unrestricted access to the Alternative Care Facility in accordance with the residency agreement or modifications as agreed to and documented in the Member's Provider Care Plan.

b. Alternative Care Facilities shall provide an outdoor area accessible to Members without staff assistance that is well maintained, facilitates community gatherings, and is appropriately equipped for the population served.

c. Alternative Care Facilities shall maintain a comfortable temperature throughout the Alternative Care Facility and Member rooms, sufficient to accommodate the use and needs of the Members, never to fall outside the range of 68 degrees to 76 degrees Fahrenheit.

d. The Alternative Care Facility shall develop and follow written policies and procedures to ensure the continuation of necessary care to all Members for at least 72 hours immediately following any emergency including, but not limited to, a long-term power failure.

e. The Alternative Care Facility Provider Agency shall display the monthly schedule of daily recreational and social engagement opportunities in a visible location so that it is always available to Members and visitors, and developed in accordance with 6 C.C.R. 1011-1, Chapter VII, Section 12.26, pertaining to Member Engagement.

i. Staff shall be responsible for ensuring that the daily schedule of recreational and social engagement opportunities is implemented and offered to all Members.

f. The Alternative Care Facility Provider Agency shall provide reading material in the common areas at all times, reflecting the interests, hobbies, and requests of the Members.

g. The Alternative Care Facility Provider Agency shall provide nutritious food and beverages that Members have access to at all times. Access to food and cooking of food shall be in accordance with 6 C.C.R. 1011-1, Chapter VII, Section 17.1-3. The access to food shall be provided in at least one of the following ways:

i. Access to the Alternative Care Facility kitchen.

ii. Access to an area separate from the Alternative Care Facility kitchen stocked with nutritious food and beverages.

iii. A kitchenette with a refrigerator, sink, and stove or microwave, separate from the Member's bedroom.

iv. A safe, sanitary way to store food in the Member's room.

h. The Alternative Care Facility Provider Agency shall assess each Member's cooking capacity shall be assessed as part of the pre-admission process and updated in the Provider Care Plan as necessary.

6. Staffing Requirements

a. Each Alternative Care Facility Provider Agency will divide the 24-hour day into two 12-hour blocks which will be considered daytime and nighttime. The designation of daytime and nighttime hours shall be permanently documented in the Alternative Care Facilities policy and disclosed in the written Member agreements. In determining appropriate staffing levels, the Alternative Care Facility Provider Agency shall adjust staffing ratios based on the individual acuity and needs of the Members in the Alternative Care Facility. At a minimum, staffing must be sufficient in number to provide the services described in the Provider Care Plan, considering the Member's needs, level of assistance, and risks of accidents. A staff person may have multiple functions, as long as they meet the definition of Direct Care Worker at Section 8.7402.F Staff counted in the staff-to-Member ratio are those who are trained and able to provide direct services to Members.

b. Staffing at an Alternative Care Facility shall meet the following standards

i. A minimum of 1 staff to 10 Members during the daytime.

ii. A minimum of 1 staff to 16 Members during the nighttime.

iii. A minimum of 1 staff to 6 Members in a Secured Environment at all times.

1) The Alternative Care Facility Provider Agency shall ensure a minimum of one awake staff member that is on duty during all hours of operation in a Secured Environment

c. Staffing Ratio Waiver

i. Staffing waiver requests shall be submitted to the Department's Alternative Care Facility Benefit Administrator. Requests will be evaluated based on several criteria including, but not limited to:

1) The number of years Alternative Care Facility has been in operation;

2) Past Incidents as defined Section at 7.402.10 at the Alternative Care Facility;

3) Whether the Alternative Care Facility Provider Agency has adequately documented how a staffing waiver would not jeopardize the health, safety or quality of life of the Members;

4) Provider availability and Member access; and

5) Whether the Alternative Care Facility Provider Agency has been free of deficiencies impacting Member health and safety in both the Colorado Department of Public Health and Environment (CDPHE) and Life Safety Code survey and inspections.

ii. An approved staffing waiver is only applicable for nighttime hours, with the exception for Secured Environments.

iii. A staffing waiver expires five years from the date of approval. No staffing waiver shall continue after the expiration of five years from the date of approval without approval by the Department.

iv. Any existing staffing waiver may be subject to revocation if an Alternative Care Facility does not comply with any applicable regulations, is cited with deficiencies impacting Member health and safety by the Colorado Department of Public Health and Environment (CDPHE) or the Division of Fire Protection Control, has substantiated patient care Complaints, or the staffing waiver has jeopardized the health, safety or quality of life of the Members.

1) In the event a staffing waiver is denial or revoked, an Alternative Care Facility may reapply for a staffing waiver only after the Alternative Care Facility receives a Colorado Department of Public Health and Environment (CDPHE) and Life Safety survey with no deficiencies impacting Member health and safety

2) Existing staffing waivers shall be null and void upon a change in the total number of licensed beds or a change of ownership in an Alternative Care Facility.

v. The Alternative Care Facility Provider Agency shall ensure that all staff and volunteer training be completed within the first 30 days of employment. Training shall include, but is not limited to, the training topics described in 6 C.C.R. 1011-1, Chapter VII, Section 7.9.

vi. The Provider Agency shall ensure the Administrator and all staff meet the qualifications and employment standards set forth in 6 C.C.R. 1011-1, Chapter VII, Section 7.4.

8.7506.GAlternative Care Facility Standards for Secured Environment

1. Alternative Care Facility Provider Agencies providing a secured environment may be licensed for a maximum of 30 secured beds.

a. A waiver may be granted by the Department when adequate documentation of the need for additional beds has been proven and the number of beds would not jeopardize the health, safety and quality of care of Members.

2. The Alternative Care Facility shall establish an environment that promotes independence and minimizes agitation and unsafe wandering through the use of visual cues and signs.

3. Provide a secured outdoor area accessible without staff assistance, which shall be level, well maintained, and appropriately equipped for the population served.

8.7506.HAppropriateness of Medicaid Participant Placement

1. Alternative Care Facilities must comply with 6 C.C.R. 1011-1 Chapter 7, Part 11 when admitting a Member or providing a 30 days' notice of discharge.

8.7506.IAlternate Care Facility Provider Agency Reimbursement Requirements

1. Room and board shall not be a benefit of Alternative Care Facility services.

2. Alternative Care Facility services shall be reimbursed according to a per diem rate, using a methodology determined by the Department.

a. Alternative Care Facility services are subject to Post Eligibility Treatment of Income (PETI), as outlined in Section 8.7202.BB.

3. Non-Medical/Programmatic Leave Reimbursement

a. The Alternative Care Facility may receive reimbursement for a maximum of 42 days in a calendar year for Non-Medical/Programmatic Leave Days combined.

b. The Alternative Care Facility shall not be reimbursed for services during Leave Days if the Member is receiving Medicaid services over 24 hours in another approved Medicaid Facility, such as a nursing facility or hospital.

10 CCR 2505-10-8.7506

47 CR 03, February 10, 2024, effective 3/16/2024

47 CR 21, November 10, 2024, effective 11/30/2024