10 Colo. Code Regs. § 2505-10-8.7525

Current through Register Vol. 47, No. 9, May 10, 2024

Section 10 CCR 2505-10-8.7525 - Home Delivered Meals

8.7525.AHome Delivered Meals Eligibility

1. Home Delivered Meals is a covered benefit available to Members enrolled in one of the following HCBS waivers:

a. Brain Injury Waiver

b. Community Mental Health Supports Waiver

c. Complementary and Integrative Health Waiver

d. Elderly, Blind, and Disabled Waiver

e. Supported Living Services Waiver

f. Development Disability Waiver

8.7525.BHome Delivered Meals Definition

1. Home Delivered Meals means nutritional counseling, planning, preparation, and delivery of meals to Members who have dietary restrictions or specific nutritional needs, are unable to prepare their own meals, and have limited or no outside assistance.

8.7525.CHome Delivered Meals Inclusions

1. To obtain approval for Home Delivered Meals, the Member must demonstrate a need for the service, as follows:

a. The Member demonstrates a need for nutritional counseling, meal planning, and preparation;

b. The Member shows documented dietary restrictions or specific nutritional needs;

c. The Member lacks or has limited access to outside assistance, services, or resources through which they can access meals with the type of nutrition vital to meeting their dietary restrictions or special nutritional needs;

d. The Member is unable to prepare meals with the type of nutrition vital to meeting their dietary restrictions or special nutritional needs;

e. The Member's inability to access and prepare nutritious meals demonstrates a need-related risk to health, safety, or institutionalization

2. To establish eligibility for Home Delivered Meals, for Members transitioning into the community, the Member must satisfy general criteria for accessing service:

a. The Member is transitioning from an institutional setting to a Home and Community-Based setting, or is experiencing a qualifying change in life circumstance that affects a Member's stability and endangers their ability to remain in the community;

b. The Member demonstrates a need to develop or sustain independence to live or remain in the community upon their transitioning; and

c. The Member demonstrates that they need the service to establish community supports or resources where they may not otherwise exist.

d. Members accessing Home Delivered Meals post-hospital discharge must have been discharged from the hospital following a 24-hour admission.

8.7525.DHome Delivered Service Requirements

1. The Member's Person-Centered Support Plan must specifically identify:

a. The Member's need for individualized nutritional counseling and development of a Nutritional Meal Plan, which describes the Member's nutritional needs and selected meal types, and provides instructions for meal preparation and delivery; and

b. The Member's specifications for preparation and delivery of meals, and any other detail necessary to effectively implement the individualized meal plan.

2. The service must be provided in the home or community and in accordance with the Member's Person-Centered Support Plan. All Home Delivered Meal services shall be documented in the Person-Centered Support Plan.

3. For Members transitioning into the community, the assessed need is documented in the Member's Person-Centered Support Plan as part of their skills acquisition process of gradually becoming capable of preparing their own meals or establishing the resources to obtain their needed meals.

4. Members transitioning into the community may be approved for Home Delivered Meals for no more than 365 days. The Department, in its sole discretion, may grant an exception based on extraordinary circumstances.

5. Members accessing meals post-hospital discharge may be approved for Home Delivered Meals for no more than 30 days post qualifying hospital discharge. Benefit may be accessed for no more than two 30-day periods during a Member's certification period.

6. Meals are to be delivered up to two meals per day, with a maximum of 14 meals delivered per week.

7. Meals may include liquid, mechanical soft, or other medically necessary types.

8. Meals may be ethnically or culturally tailored.

9. Meals may be delivered hot, cold, frozen, or shelf-stable, depending on the Member's or caregiver's ability to complete the preparation of, and properly store the meal.

10. The provider shall confirm meal delivery to ensure the Member receives the meal in a timely fashion, and to determine whether the Member is satisfied with the quality of the meal.

11. For Members transitioning into the community, the providing Agency's certified RD or RDN will check in with the Member no less frequently than every 90 days to ensure the meals are satisfactory, that they promote the Member's health, and that the service is meeting the Member's needs.

12. For Members transitioning into the community, the RD or RDN will review a Member's progress toward the nutritional goal(s) described in the Member's Person-Centered Support Plan no less frequently than once per calendar quarter, and more frequently, as needed.

13. For Members transitioning into the community, the RD or RDN shall make changes to the Nutritional Meal Plan if the quarterly Assessment results show changes are necessary or appropriate.

a. For Members transitioning into the community, the RD or RDN will send the Nutritional Meal Plan to the Case Management Agency no less frequently than once per quarter to allow the Case Management Agency to verify the plan with the Member during the quarterly check-in, and to make corresponding updates to the Person-Centered Support Plan, as needed.

8.7525.EHome Delivered Meals Exclusions and Limitations

1. Home Delivered Meals are not available when the Member resides in a provider-owned or controlled setting.

2. Delivery must not constitute a full nutritional regimen and includes no more than two meals per day or 14 meals per week.

3. Items or services through which the Member's need for Home Delivered Meal services may otherwise be met, including any item or service available under the State Plan, applicable HCBS waiver, or other resources are excluded.

4. Meals not identified in the Nutritional Meal Plan or any item outside of the meals not identified in the meal plan, such as additional food items or cooking appliances are excluded.

5. Meal plans and meals provided are reimbursable when they benefit the Member, only. Services provided to someone other than the Member are not reimbursable.

8.7525.FHome Delivered Provider Agency Requirements

1. A licensed provider enrolled with Colorado Medicaid to provide the Home Delivered Meal service must be a legally constituted domestic or foreign business entity registered with the Colorado Secretary of State Colorado and holding a Certificate of Good Standing to do business in Colorado.

2. Home Delivered Meal providers must conform to all general Certification standards, conditions, and processes established in Section 8.7400.

3. The provider shall maintain licensure as required by the State of Colorado Department of Public Health and Environment (CDPHE) for the performance of the service or support being provided, including necessary Retail Food License and Food Handling License for staff; or be approved by Medicaid as a home delivered meals provider in their home state.

4. Must maintain a Registered Dietitian (RD) OR Registered Dietitian Nutritionist (RDN) on staff or under contract.

5. The provider shall maintain meals documentation in accordance with Section 8.7405 and shall provide documentation to supervisor(s), program monitor(s) and auditor(s), and CDPHE surveyor(s) upon request. Required documentation includes:

a. Documentation pertaining to the Provider Agency, including employee files, claim submission documents, program and financial records, insurance policies, and licenses, including a Retail Food License and Food Handling License for Staff, or, if otherwise applicable, documentation of compliance and good standing with the City and County municipality in which this service is provided; and

b. Documentation pertaining to services, including:

i. Documentation of any professionally recommended dietary restrictions or specific nutritional needs;

ii. Member demographic information;

iii. A Meal Delivery Schedule;

iv. Documentation of special diet requirements;

v. A determination of the type of meal to be provided (e.g. hot, cold, frozen, shelf stable);

vi. A record of the date(s) and place(s) of service delivery;

vii. Monitoring and follow-up (contacting the Member after meal deliver to ensure the Member is satisfied with the meal); and

viii. Provision of nutrition counseling or documentation of Member declination.

8.7525.GHome Delivered Meals Provider Agency Reimbursement

1. Home Delivered Meals services are reimbursed based on the number of units of service provided, with one unit equal to one meal.

2. Payment for Home Delivered Meals shall be the lower of the billed charges or the maximum rate of reimbursement.

3. Reimbursement is limited to services described in the Person-Centered Support Plan.

10 CCR 2505-10-8.7525

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