Rule 23-208-7.5 - Covered ServicesA. A person can receive: 1. 1915(i) services if not eligible for services available: a) For Prevocational Services under a program funded under Section 110 of the Rehabilitation Act of 1973 or Sections 602(16) and (17) of the Individuals with Disabilities Education Act, 20 U.S.C. 1401(16) and (17), or b) For Supported Employment under Section 110 of the Rehabilitation Act of 1973 or the Individuals with Disabilities Education Act (20 U.S.C. 1401 et seq.). 2. Only those 1915(i) services which are documented on the Plan of Services and Supports (PSS) by the Case Manager and approved by the Department of Mental Health (DMH), and 3. Multiple 1915(i) services on the same day but not during the same time of the day. B. Transportation between the person's residence, other habilitation sites and the employment site is a component part of Habilitation Services. 1. The cost of transportation is included in the rate paid to the provider. 2. Providers cannot bill separately for transportation services and cannot charge the persons for transportation. C. The 1915(i) State Plan services are: 1. Day Habilitation Services defined by the Division of Medicaid as services designed to assist the person with acquisition, retention, or improvement in self-help, socialization, and adaptive skills. Activities and environments are designed to foster the acquisition and maintenance of skills, building positive social behavior and interpersonal competence, greater independence and personal choice. Day Habilitation Services: a) Must take place in a non-residential setting separate from the home or facility in which the person resides. b) Settings must be physically accessible to the person and must: 1) Be integrated in and supports full access of persons receiving Medicaid Home and Community-Based Settings (HCBS) to the greater community, including opportunities to seek employment and work in competitive integrated settings, engage in community life, control personal resources, and receive services in the community, to the same degree of access as individuals not receiving Medicaid HCBS. 2) Be selected by the person from among setting options including non-disability specific settings. The setting options are identified and documented in the person-centered service plan and are based on the person's needs, preferences. 3) Ensure a person's rights of privacy, dignity and respect, and freedom from coercion and restraint. 4) Optimize, but not regiment, a person's initiative, autonomy, and independence in making life choices, including but not limited to, daily activities, physical environment, and with whom to interact. 5) Facilitate individual choice regarding services and supports, and who provides them. c) Do not include the following: 2) An institution for mental diseases, 3) An intermediate care facility for individuals with intellectual disabilities (ICF/IID), 5) Any other locations that have qualities of an institutional setting, as determined by the Division of Medicaid, including but not limited to, any setting: (a) Located in a building that is also a publicly or privately operated facility that provides inpatient institutional treatment, (b) Located in a building on the grounds of or immediately adjacent to a public institution, or (c) Any other setting that has the effect of isolating persons receiving Medicaid Home and Community-Based Services (HCBS). d) Must be furnished four (4) or more hours per day on a regularly scheduled basis, for one (1) or more days per week, or as specified in the person's PSS. e) Must be provided in DMH certified sites/community settings. 2. Prevocational Services defined by the Division of Medicaid as services to prepare a person for paid employment. Services address underlying habilitative goals which are associated with performing compensated work. Services include, but are not limited to, teaching concepts such as compliance, attendance, task completion, problem solving and safety. Services are not job task oriented but instead are aimed at a generalized result. Prevocational Services: a) Must be included in the person's PSS and be directed towards habilitative objectives and not explicit employment objectives. b) Provide choices of food and drinks to persons at any time during the day to meet their nutritional needs which includes, at a minimum: c) May include personal care/assistance as a component but it cannot comprise the entirety of the service. Beneficiaries cannot be denied Prevocational Services because they require assistance from staff with toileting and/or personal hygiene. d) Beneficiaries must be compensated in accordance with applicable federal laws and regulations. If a person is performing productive work as a trial work experience that benefits the provider or that would have to be performed by someone else if not performed by the person, the provider must pay the person commensurate with members of the general work force doing similar work per federal wage and hour regulations. e) Must be reviewed for necessity and appropriateness by the person, appropriate staff and the Case manager if the person earns more than fifty percent (50%) of the minimum wage. f) Providers must inform beneficiaries about Supported Employment opportunities and other competitive employment activities in the community on an annual basis. g) May be furnished in a variety of locations in the community and are not limited to fixed program locations. Community job exploration activities must be offered to each person at least one (1) time per month. h) Include transportation. Time spent in transportation to and from the program cannot be included in the total number of service hours provided per day, unless it is for the purpose of training. i) Settings must be physically accessible to the person and must: 1) Be integrated in and supports full access of persons receiving Medicaid HCBS to the greater community, including opportunities to seek employment and work in competitive integrated settings, engage in community life, control personal resources, and receive services in the community, to the same degree of access as individuals not receiving Medicaid HCBS. 2) Be selected by the person from among setting options including non-disability specific settings and an option for a private unit in a residential setting. The setting options are identified and documented in the person-centered service plan and are based on the person's needs and preferences. 3) Ensure a person's rights of privacy, dignity and respect, and freedom from coercion and restraint. 4) Optimize, but not regiment, a person's initiative, autonomy, and independence in making life choices, including but not limited to, daily activities, physical environment, and with whom to interact. 5) Facilitate individual choice regarding services and supports, and who provides them. c) Settings do not include the following: 2) An institution for mental diseases, 3) An intermediate care facility for individuals with intellectual disabilities, 5) Any other locations that have qualities of an institutional setting, as determined by the Division of Medicaid, including but not limited to, any setting: (a) Located in a building that is also a publicly or privately operated facility that provides inpatient institutional treatment, (b) Located in a building on the grounds of, or immediately adjacent to a public institution, or (c) Any other setting that has the effect of isolating persons receiving Medicaid Home and Community-Based Services (HCBS). 3. Supported Employment services defined by the Division of Medicaid as intensive, ongoing support to persons who, because of their disabilities, require support to obtain and maintain an individual job in competitive or customized employment, or self-employment. Employment must be in an integrated setting in the general workforce for whom a person is compensated at or above the minimum wage but not less than the customary wage and level of benefits paid by the employer for the same or similar work performed by persons without disabilities. Supported Employment: a) Is based on an Activity Plan that must be developed for each person based on his/her PSS. b) Includes assessment, job development and placement, job training, negotiation with prospective employers, job analysis, systematic instruction, and ongoing job support and monitoring. c) Includes services and supports to assist the person in achieving self-employment through the operation of a home or community based business, and may include the following: 1) Aiding the person in identifying potential business opportunities. 2) Assisting in the development of a business plan, including potential sources of financing and other assistance in developing and launching a business. 3) Identifying supports necessary for the person to successfully operate the business. 4) On-going assistance, counseling and guidance once the business has launched. d) Cannot use Medicaid funds to defray the expenses associated with starting or operating a business. e) Must be provided at work sites where persons without disabilities are employed and where payment is made only for the adaptations, supervision, and training required by beneficiaries receiving 1915(i) services and does not include payment for the supervisory activities rendered as a normal part of the business setting. f) Must include transportation between the person's place of residence and the site of the person's job or between or between habilitation sites (in cases where the person receives habilitation services in more than one place) as a component of supported employment. Transportation cannot comprise the entirety of the service. g) May include personal care/assistance as a component of Supported Employment but cannot comprise the entirety of the service. h) Do not include sheltered work or other similar types of vocational services furnished in specialized facilities or volunteer work. 23 Miss. Code. R. 208-7.5
42 U.S.C. § 1396n; 42 C.F.R. § 441.710; Miss. Code Ann. § 43-13-121.New to correspond with SPA 2013-001 (eff. 11/01/2013) eff. 04/01/2014.