10 Colo. Code Regs. § 2505-10-8.7546
Current through Register Vol. 47, No. 24, December 25, 2024
Section 10 CCR 2505-10-8.7546 - Child Respite8.7546.AChild Respite Eligibility1. Child Respite is a covered benefit available to Members enrolled in one of the following HCBS waivers:a. Children with Life Limiting Illnessb. Children's Extensive Support Waiverc. Children's Habilitation Residential Program8.7546.BChild Respite Definition1. Child Respite care means services provided to an eligible Member on a short-term basis because of the absence or need for relief of those persons who normally provide the care.2. Unskilled Respite means services provided to an eligible Member by a trained and unlicensed support staff.3. Skilled Respite means services provided to an eligible Member by a licensed RN/LPN/or CNA. These services must qualify as skilled care as prescribed by a Licensed Medical Professional.4. Therapeutic Respite means services provided to an eligible Member by a specially-trained and certified support provider for ongoing behavioral support needs.8.7546.CChild Respite Inclusions1. HCBS Children's Extensive Supports (CES) Waivera. Respite may be provided in the Member home or private residence;b. The private residence of a respite care provider; or2. HCBS Children with Life Limiting Illness (CLLI) Waiver a. Respite care may be provided in the home;c. In an approved respite center location of a Member.3. HCBS Children's Habilitation Residential Program Waiver (CHRP) Waiver a. Respite services may be provided in a certified Foster Care Home;b. Kinship Foster Care Home;c. Licensed Residential Child Care Facility;d. Licensed Specialized Group Facility, Licensed Child Care Center (less than 24 hours);e. in the Family home; org. Overnight or out of home Respite must be in a Foster Care Home, Kinship Home, Group Home, or Residential Child Care Facility (RCCF).8.7546.DChild Respite Exclusions and Limitations1. HCBS Children's Extensive Supports (CES) Waivera. Respite is to be provided in an age-appropriate manner. Respite is not a covered benefit for Member 11 years of age and younger during the time the primary caregiver is at work, pursuing continuing education or engaging in volunteer activities.b. When the cost of care during the time the caregiver at work is more for a Member 11 years of age or younger, than it is for same age peers, respite may be used to pay the difference in costs. Caregivers shall be responsible for the basic and typical costs of childcare.2. HCBS Children with Life Limiting Illness (CLLI) Waiver a. Respite care shall not be provided at the same time as Home Health or Palliative/Supportive Care services.8.7546.EChild Respite Provider Reimbursement Requirements1. HCBS Children's Extensive Supports (CES) Waivera. Respite shall be provided according to an individual or group rates as defined below: Individual: the Member receives respite in a one-on-one situation. There are no other Members in the setting also receiving respite services.b. Unskilled Individual day: the Member receives respite in a one-on-one situation for cumulatively more than 10 hours in a 24-hour period. A full day is 10 hours or greater within a 24-hour period.c. Skilled and Therapeutic Individual day: the Member receives respite in a one-on-one situation for cumulatively more than four hours in a 24-hour period. A full day is four hours or greater within a 24-hour period.d. Overnight group: the Member receives respite in a setting which is defined as a facility that offers twenty-four (24) hour supervision through supervised overnight group accommodations. The total cost of overnight group within a twenty-four (24) hour period shall not exceed the respite daily rate.e. Group: the Member receives care along with other individuals, who may or may not have a disability. The total cost of the group rate within a twenty-four (24) hour period shall not exceed the respite daily rate. The following limitations to respite service shall apply:f. The total amount of respite provided in one support plan year may not exceed an amount equal to 30 day units and 1,880 15-minute units. The Department may approve a higher amount based on a need due to the Member's age, disability or unique Family circumstances.g. Overnight group respite may not substitute for other services provided by the provider such as Personal Care, Behavioral Services or other services not covered by the HCBS- CES waiver.h. Respite shall be reimbursed according to a unit rate or daily rate whichever is less. The daily overnight or group respite rate shall not exceed the respite daily rate.i. The purpose of respite is to provide the primary caregiver a break from the ongoing daily care of a Member. Therefore, additional respite units beyond the service limit will not be approved for Members who receive skilled nursing, certified nurse aide services, or home care allowance from the primary caregiver.2. HCBS Children with Life Limiting Illness (CLLI) Waiver a. Respite is not to exceed thirty (30) days per support plan year, as determined by the Department approved Assessment.3. HCBS Children's Habilitation Residential Program Waiver (CHRP) Waiver a. The total amount of respite provided in one support plan year may not exceed an amount equal to thirty (30) day units and one thousand eight hundred eighty (1,880) individual units, where one unit is equal to 15 minutes. The Department may approve a higher amount when needed due to the Member's age, disability or unique Family circumstances.b. During the time when Respite care is occurring, the Foster Care Home or Kinship Care Home may not exceed six (6) foster children or a maximum of eight (8) total children, with no more than two (2) children under the age of two (2). The respite home must be in compliance with all applicable rules and requirements for Family Foster Care Homes.c. Respite is available for children or youth living in the Family home and may not be utilized while the Member is receiving Habilitation services.47 CR 03, February 10, 2024, effective 3/16/202447 CR 21, November 10, 2024, effective 11/30/2024