10 Colo. Code Regs. § 2505-10-8.7553
Current through Register Vol. 47, No. 24, December 25, 2024
Section 10 CCR 2505-10-8.7553 - Transitional Living Program8.7553.ATransitional Living Program Eligibility1. Transitional living Program is a covered benefit available to Members enrolled in the HCBS Brain Injury Waiver.8.7553.BTransitional Living Program Definition1. The Transitional living Program is a residential service designed to improve the Member's ability to live in the community by provision of 24-hour services, support and supervision.8.7553.CTransitional Living Program Inclusions1. All services must be documented in an approved plan of care and be prior authorized by the Department.2. Program services include but are not limited to Assessment, therapeutic rehabilitation and habilitation, training and supervision of self-care, medication management, communication skills, interpersonal skills, socialization, sensory/motor skills, money management, and ability to maintain a household.3. Extraordinary therapeutic needs mean, for purposes of this program, a Member who requires more than three hours per day of any combination of therapeutic disciplines. This includes, but is not limited to, physical therapy, occupational therapy, and speech therapy.8.7553.DTransitional Living Program Exclusions and Limitations1. The per diem rate paid to transitional living programs shall be inclusive of standard therapy and nursing charges necessary at this Level of Care. If a Member requires extraordinary therapy, additional services may be sought through outpatient services as a benefit of regular Medicaid services. The need for the Transitional Living Program service for a Member must be documented and authorized individually by the Department.2. Transportation between therapeutic tasks in the community, recreational outings, and Activities of Daily Living is included in the per diem reimbursement rate and shall not be billed as separate charges.3. Transportation to outpatient medical appointments is exempted from transportation restrictions noted above.4. Room and board shall not be a benefit of Transitional Living Program services, set forth at Section 8.7414.5. Items of personal need or comfort shall be paid out of money set aside from the Member's income and accounted for in the determination of Financial Eligibility for the Brain Injury program.6. The duration of transitional living services shall not exceed 6 months without additional approval, treatment plan review and reauthorization by the Department.8.7553.ETransitional Living Program Provider Agency Requirements1. Policies a. The Provider Agency shall confirm that Members must have sustained recent neurological damage (within 18 months) or have realized a significant, measurable, and documented change in neurological function within the past three months. This change in neurological function must have resulted in hospitalization. b. The Provider Agency shall inform Members and Legally Authorized Representatives of the inherent risk associated with participation in a community-based transitional living program. Examples might include a greater likelihood of falls in community outings where curbs are present.c. The Provider Agency shall confirm that Members need available assistance in a congregate setting for safety and supervision and require support in meeting psychosocial needs.d. The Provider Agency shall confirm that Members require available paraprofessional nursing assistance on a 24-hour basis due to dependence in Activities of Daily Living, locomotion, or cognition.e. Understanding that Members of transitional living programs frequently experience behavior which may be a danger to themselves or others, the Provider Agency shall ensure the program will be suitably equipped to handle such behaviors without posing a significant threat to other residents or staff. The Provider Agency shall have written agreements with other providers in the community who may provide short term Crisis intervention to provide a safe and secure environment for a Member who is experiencing severe behavioral difficulties, or who is actively homicidal or suicidal.f. The history of behavior problems shall not be sufficient grounds for denying access to transitional living services: however, programs shall retain clinical discretion in refusing to serve Members for whom they lack adequate resources to ensure safety of program Members and staff.g. Upon entry into the program, discharge planning shall begin with the Member and family. Transitional living programs shall work with the Member and Case Manager to develop a program of services and support which leads to the location of a permanent residence at the completion of transitional living program services.h. Transitional living programs shall provide assurances that the services will occur in the community or in natural settings and be non-institutional in nature.i. During daytime hours, 7:00 am to 7:00 pm, the ratio of staff to Members shall be at least 1:3 and overnight, shall be at least 2:8. The use of contract employees, except in the case of an unexpected staff shortage during documented emergencies, is not acceptable.j. The duration of transitional living services shall not exceed six months without additional approval, treatment plan review and re-authorization by the Department.2. Training a. At a minimum, the program director shall have an advanced degree in a health or human service-related profession plus three years of experience providing direct services to Members with a Brain Injury. A bachelor's degree with five years of experience or similar combination of education and experience shall be an acceptable substitute for a master's level education.b. Transitional living programs shall demonstrate and document that employees providing direct care and support have the educational background, relevant experience, and/or training to meet the needs of the Member. These staff Members shall have successfully completed a training program of at least 40 hours duration.c. Transitional living Program Provider Agencies must satisfactorily complete an introductory training course on Brain Injury and rules and regulations pertaining to transitional living centers prior to Certification of the Transitional living Program.d. The provider, staff, and volunteers who provide direct Member care or Protective Oversight as defined at 8.7506.B.2 must be trained in first aid Universal Precautions, emergency procedures, and at least one staff per shift shall be certified as a medication aide prior to assuming responsibilities. Transitional living Program's certified prior to the effective date of these rules shall have 60 days to satisfy this training requirement.e. Training in the use of Universal Precautions for the control of infectious or communicable disease shall be required of all operators, staff, and volunteers. Transitional living Program's certified prior to the effective date of these rules shall have 60 days to satisfy this training requirement.f. Staffing of the program must include at least one individual per shift who has Certification as a medication aide prior to assuming responsibilities.8.7553.FTransitional Living Program Provider Reimbursement Requirements1. Room and board shall not be a benefit of Transitional living Program services.2. Transitional living Program services shall be reimbursed according to a per diem rate, using a methodology determined by the Department.47 CR 03, February 10, 2024, effective 3/16/202447 CR 21, November 10, 2024, effective 11/30/2024