-DRAFT- April 29, 2015

Transcription

1 -DRAFT- April 29, 2015 ANNEX TITLE 55. HUMAN SERVICES PART VIII. INTELLECTUAL DISABILITY MANUAL SUBPART C. ADMINISTRATION AND FISCAL MANAGEMENT CHAPTER SUPPORT FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR AUTISM GENERAL PROVISIONS Purpose Applicability Definitions Individual eligibility for HCBS. GENERAL REQUIREMENTS Appeals Monitoring compliance Regulatory waivers Quality management Abuse management Criminal history checks Approval, funding, hiring, retention and utilization Child abuse checks Communication Complaints Conflict of interest Recordkeeping. ENROLLMENT Provider requirements Ongoing provider qualifications Submission of qualification documentation Provision, update and verification of information Delivery of support Documentation Annual training plan Pre-enrollment training Orientation Annual training. TRAINING INDIVIDUAL RIGHTS AND CHOICES Informing and encouraging the exercise of rights and choices Exercise of rights and choices. 1

2 Rights and choices of the individual Additional rights and choices of the individual in residential habilitation. PERSON-CENTERED SUPPORT PLAN Development of the person-centered support plan (PSP) The PSP process Content of the PSP Implementation of the PSP Support service coordination and targeted support management Documentation of support delivery. EMPLOYMENT AND COMMUNITY PARTICIPATION Access to the community Opportunities for employment. TRANSITION Individual choice Transition to a new provider Reasons for discharge or transfer Written notice Continuation of supports Health and safety risk Supports coordination Transition of records. SAFE BEHAVIOR MANAGEMENT Positive interventions Person-centered support plan Prohibition of certain restraints Use or access to the individual s personal property. INCIDENT MANAGEMENT Types of incidents and timelines for reporting Incident investigation Incident report Individual needs Incident analysis. PHYSICAL ENVIRONMENT Request for and approval of changes Physical accessibility Access to the bedroom and the home Lease Integration. MEDICATION ADMINISTRATION Self-administration Medication administration Storage and disposal of medications Labeling of medications Prescription medications. 2

3 Medication records Medication errors Adverse reaction Medication administration training. GENERAL PAYMENT PROVISIONS Departmental rates and classifications Payment Capital assets of residential buildings Provider billing Audits Bidding Loss or damage to property Fee schedule rates. FEE SCHEDULE VENDOR GOODS AND SERVICES Vendor Direct payment Payment for goods or services Administrative fee Same cost as to general public Subcontractor. COST-BASED RATES AND ALLOWABLE COSTS Cost-based rates Assignment of rates Submission of cost reports Cost reports Rate-setting Cost-based rates for residential habilitation through June Cost-based rates for residential habilitation from July 2017 through June Allowable costs Donations Management fees Consultants and contractors Governing board Compensation Training Staff recruitment Travel Supplies and equipment Communications Rental of administrative space Other occupancy and allocated occupancy expenses Fixed assets Motor vehicles Capital assets of administrative buildings. 3

4 Residential habilitation vacancy Indirect costs Moving expenses Interest expense Insurance Other allowable costs Start-up cost authorization Reporting of start-up expenses Caps on start-up cost. ROOM AND BOARD Room and board applicability Support to the individual Room and board rate Documentation No delegation permitted Respite care Hospitalization Exception Actual room and board costs Completing and signing the room and board contract Modifications to the room and board contract Copy of room and board contract Delay in an individual s income Benefits. DEPARTMENT-ESTABLISHED FEES Department-established fees. ENFORCEMENT Sanctions Array of sanctions Consideration as to type of sanction utilized Additional conditions and sanctions. SPECIAL PROGRAMS Adult autism waiver Support coordination Targeted support management Organized health care delivery system Base-funded only Purpose. GENERAL PROVISIONS The purpose of this chapter is to support Pennsylvanians with an intellectual disability or autism to achieve greater independence, choice and opportunity in their lives, through the effective and efficient delivery of home and community-based waiver supports (HCBS), 4

5 targeted support management (TSM) and supports to individuals provided through basefunding Applicability. (a) This chapter applies to HCBS that are funded and provided in accordance with the following Federally approved 1915(c) waiver programs: (1) Adult autism. (2) Consolidated. (3) Person/family directed support. (4) Other HCBSs. (b) This chapter applies to the following: (1) Support coordination. (2) TSM. (3) Intellectual disability programs, staffing or individual supports that are funded exclusively through base-funding in accordance with Chapter 4300 (relating to county mental health and mental retardation fiscal manual). (c) This chapter does not apply to the following: (1) Intermediate care facilities licensed in accordance with Chapter 6600 (relating to intermediate care facilities for the mentally retarded). (2) Hospitals licensed in accordance with 28 Pa.Code Chapters (relating to general and specific hospitals). (3) Nursing facilities licensed in accordance with 28 Pa.Code Chapters (relating to long term care nursing facilities). (4) Personal care homes licensed in accordance with Chapters 2600 (relating to personal care homes). (5) Assisted living residences licensed in accordance with Chapters 2800 (relating to assisted living residences). (6) Mental health facilities licensed in accordance with Chapters 5200, 5210, 5221, 5230, 5300 and (7) Privately-funded programs, supports and placements. (8) Placements by other states into Pennsylvania Definitions. Administrative entity An organization that is designated by the Department to act on the Department s behalf. Applicant A person who is in the process of enrollment in the HCBS waiver program. Department - The Pennsylvania Department of Human Services. Individual - A person who receives home and community-based intellectual disability or autism waiver support, targeted support management or base-funding support. Provider The person, entity or agency that is responsible to deliver the support to the individual. This includes a vendor as defined at (relating to vendor) Individual eligibility for intellectual disability HCBS. 5

6 (a) A person shall be eligible for an intellectual disability HCBS if the following criteria are met: (1) The person has a diagnosis of intellectual disability. The diagnosis of intellectual disability shall be determined by a licensed psychologist, certified school psychologist, psychiatrist or licensed physician who practices psychiatry, based on the results of the standardized general intelligence test indicate performance that is more than two standard deviations below the mean of a standardized general intelligence test, plus or minus the standard testing variance, including both performance and verbal areas that are two standard deviations below the mean. (2) The person requires active treatment and an intermediate level of care for individuals with intellectual disabilities with an impairment in adaptive behavior based on the results of a standardized assessment of adaptive functioning that indicates that the individual has either of the following: (i) (ii) life activity: A significant limitation in meeting the standards of maturation, learning, personal independence or social responsibility of his age and cultural group. A substantial functional limitation in three or more of the following areas of major (A) Self-care. (B) Receptive and expressive language. (C) Learning. (D) Mobility. (b) The licensed psychologist, certified school psychologist, psychiatrist or licensed physician who practices psychiatry shall document the following: (i) The person has had the conditions of intellectual and adaptive functioning manifested during the developmental period from birth to the age of 22. (ii) The person has an intellectual disability with the corresponding ICD 10 code. (iii) The results are valid and consistent with the person s degree of functional restriction. GENERAL REQUIREMENTS Appeals. Appeals related to this chapter shall be made in accordance with Ch. 41 (relating to medical assistance provider appeal procedures) Monitoring compliance. (a) The Department may monitor compliance with this chapter at any time, through an audit, a fiscal review or a provider monitoring assessment. (b) A provider s policies, procedures, records and invoices may be reviewed, and the provider may be required to provide a written explanation of its policies, procedures, records and invoices, related to compliance with this chapter or applicable Federal or Commonwealth statutes and regulations, during an audit, a fiscal review or provider monitoring. (c) The provider monitoring assessment will measure the provider s compliance with this chapter. (d) A provider shall complete the Department s self-monitoring assessment. 6

7 (e) A provider shall cooperate with the Department and the administrative entity and provide the requested regulatory compliance documentation prior to, during and following an audit, a fiscal review or a monitoring assessment, in the format required by the Department. (f) A provider shall cooperate with authorized Federal and Commonwealth regulatory agencies and provide the requested regulatory compliance documentation, in the format required by the regulatory agencies. (g) A provider shall complete a corrective action plan for a violation or an alleged violation of this chapter, on a form specified by the Department and in the timeframe required by the Department. (h) A provider shall comply with the corrective action plan, as approved by the Department or the administrative entity. (i) The Department may issue a directed corrective action plan to direct the provider to complete a specified course of action to correct a violation or alleged violation of this chapter. (j) The directed corrective action plan in (i) may include the direction to acquire and complete education, technical consultation, monitoring, audits or oversight by an appropriate agency, or another appropriate course of action to correct the violation, at the provider s expense. (k) A provider shall keep documentation relating to an audit, a fiscal review and a provider monitoring assessment, including supporting compliance documents Regulatory waivers. (a) A provider may submit a request for a waiver of a section, subsection, paragraph or subparagraph of this chapter, except for the following: (1) (relating to general provisions). (2) (relating to general requirements). (3) (relating to individual rights and choices). (b) The waiver shall be submitted on a form specified by the Department. (c) The Secretary or the Secretary s designee may grant a waiver if the following conditions are met: (1) There is no jeopardy to an individual s health, safety and well-being. (2) An individual or group of individuals benefit from the granting of the waiver by providing increased independence, choice, opportunity, flexibility or community participation in the supports that the individual receives. (3) There is no violation of the applicable Federally-approved waiver or applicable Federally-approved waiver amendments. (d) A waiver that is granted will specify an effective date and an expiration date. (e) At least 45 days prior to the submission of a request for a waiver the provider shall provide a written copy of the waiver request to the affected individuals, and to persons designated by the individuals, allowing at least 20 days for review and comment to the provider, the administrative entity and the Department. (f) If the request for a waiver involves the immediate protection of an individual s health and safety, the provider shall provide a written copy of the waiver request to the affected individuals, and to persons designated by the individuals, at least 5 days prior to the submission of the request for a waiver, allowing at least 3 days for review and comment to the provider, the administrative entity and the Department. 7

8 (g) The provider shall discuss and explain the request for a waiver with the affected individuals, and with persons designated by the individuals. (h) The request for a waiver shall include copies of comments received by the individuals or by persons designated by the individuals. (i) The provider shall notify the affected individuals, and persons designated by the individuals, of the waiver decision. (j) The provider shall submit a request for the renewal of a waiver at least 60 days prior to the expiration of the waiver. (k) A request for the renewal of a waiver shall follow the procedures specified in (a) (i). (l) A provider shall notify an individual who is receiving a new home and community based support, or who is receiving a support at a new location, of an existing waiver that affects the individual Quality management. (a) The provider shall develop and implement a quality management plan in accordance with the Department s criteria and priorities as published by notice in the Pennsylvania Bulletin. (b) The provider shall conduct a review of performance data in the following areas to evaluate progress and identify areas for improvement: (1) Progress in meeting the desired outcomes of the person-centered support plans (PSP). (2) Incident management, to encompass a trend analysis of the incident data including the reporting, investigation, suspected causes and corrective actions taken in response to incidents. (3) Performance in accordance with 42 CFR (relating to state assurances). (4) Complaints, as specified in (relating to complaints), to encompass a trend analysis of the complaint data. (5) Individual satisfaction survey results and informal comments by individuals and families. (6) An analysis of the successful learning and application of training. (7) Employee satisfaction survey results and employee suggestions for improvement. (8) Employee turnover rates, by position and suspected causes. (9) Licensing and provider monitoring reports. (c) The quality management plan shall identify the plans for systemic improvement and measures to evaluate the success of the plan. (d) The provider shall review and document progress on the quality management plan quarterly. (e) The provider shall analyze and revise the quality management plan every two years Abuse management. (a) Abuse is the occurrence of one of the following acts: (1) The infliction of injury, confinement, intimidation or punishment with resulting physical pain, harm or mental anguish. (2) The willful deprivation of goods or services necessary to maintain physical or mental health. (3) Rape, sexual assault or sexual harassment. 8

9 (4) An act of abuse as defined by applicable statute or regulation. (b) Abuse, suspected abuse and alleged abuse of an individual, regardless of the alleged location or alleged perpetrator of the abuse, shall be reported and managed in accordance with the following: (1) Adult Protective Services Act (35 P.S ) and applicable adult protective services regulations. (2) Child Protective Services Act (23 Pa.C.S ). (3) Chapter 3490 (relating to child protective services). (4) Older Adult Protective Services Act (35 P.S ). (5) 6 Pa.Code, Chapter 15 (relating to protective services for older adults). (c) If there is an incident of abuse, suspected abuse or alleged abuse of an individual involving an employee, consultant or volunteer, the employee, consultant or volunteer shall have no direct contact with an individual until the abuse investigation is concluded and the investigating agency has confirmed that no abuse has occurred. (d) In addition to the reporting required in (a), the provider shall immediately report the abuse, suspected abuse or alleged abuse to the following: (1) The individual. (2) Persons designated by the individual. (3) The Department. (4) The administrative entity Criminal history checks. (a) Criminal history checks shall be completed for persons who deliver reimbursed supports or who may have direct contact with individuals. This applies to all staff persons, consultants, volunteers, supports coordinators, targeted support managers, household members and the individual s friends and family members who provide reimbursed supports, and who may have direct contact with an individual, regardless of the scope of the Older Adult Protective Services Act (35 P.S ), 6 Pa.Code, Chapter 15 (relating to protective services for older adults), the Child Protective Services Act (23 Pa.C.S ) and Chapter 3490 (relating to child protective services). (b) Criminal history checks as specified in (a), for persons who provide reimbursed supports to adults, shall be completed in accordance with the Older Adult Protective Services Act and 6 Pa.Code, Chapter 15. (c) Criminal history checks as specified in (a), for persons who provide reimbursed supports to individuals who are under 18 years of age, shall be completed in accordance with the Child Protective Services Act and Chapter Approval, funding, hiring, retention and utilization. Approval, funding, hiring, retention and utilization of staff persons, consultants, volunteers, support coordinators, targeted support managers, household members and the individual s friends and family members who provide reimbursed supports shall be in accordance with the Older Adult Protective Services Act (35 P.S ) and 6 Pa.Code, Ch 15 (relating to protective services for older adults). 9

10 Child abuse checks. (a) Child abuse checks shall be completed for all persons who deliver reimbursed supports to children or who may have direct contact with individuals who are under 18 years of age. This applies to staff persons, consultants, volunteers, supports coordinators, targeted support managers, household members and the individual s friends and family members who provide reimbursed supports, and who may have direct contact with individuals, regardless of the scope of the Child Protective Services Act (23 Pa.C.S ) and Chapter 3490 (relating to child protective services). (b) Child abuse checks as specified in (a) shall be completed in accordance with the Child Protective Services Act and Chapter Communication. Written and oral communication with the individual, and persons designated by the individual, shall occur in a language and means of communication understood by the recipient Complaints. (a) The provider shall develop complaint procedures to receive, document and manage complaints. (b) The provider shall inform the individual, and persons designated by the individual, of the right to file a complaint and the procedure for filing a complaint. (c) The provider shall permit and respond to oral and written complaints from any source, including an anonymous source, regarding the delivery of a support. (d) The provider shall assure that there is no retaliation or threat of intimidation relating to the filing or investigation of complaints. (e) If an individual indicates the desire to file a complaint in writing, assistance shall be provided to the individual to prepare and submit the written complaint. (f) All complaints, including repeated complaints, shall be documented and managed. (g) The following information shall be documented for each complaint, including oral and written complaints, from any source: (1) The name, position, telephone, address and mailing address of the person filing the complaint, if applicable. (2) The date and time the complaint was received. (3) The date of the occurrence, if applicable. (4) The nature of the complaint. (5) The provider s investigation process and findings relating to the complaint. (6) The provider s actions to investigate and resolve the complaint, if applicable. (7) The date the complaint was resolved. (h) The complaint shall be resolved within 21 days from the date the complaint was received Conflict of interest. (a) A provider shall develop a conflict of interest protocol that, at a minimum, addresses the following areas: (1) Unbiased decision making by the provider, managers and staff persons. 10

11 (2) No involvement of board members with other providers that are not in accordance with ethical standards of financial and professional conduct. (3) Procedures to determine whether a conflict of interest exists within the organization, including the steps to take if a change in circumstances occurs. (4) Procedures to follow when a conflict of interest is disclosed. (5) Procedures to follow when a conflict of interest is determined to exist. (b) A provider shall disclose a conflict of interest to the Department Recordkeeping. (a) Records, documents, information and financial books as required by this chapter shall be kept by the provider for at least four years from the Commonwealth s fiscal year-end, or four years from the provider s fiscal year end, whichever is later, and until any audit or litigation is resolved, which is later, and in accordance with Federal and Commonwealth statute and regulation. (b) If a program is completely or partially terminated, the records relating to the terminated program shall be kept for at least five years from the date of termination Provider requirements. ENROLLMENT Prior to enrolling as a provider of HCBS, and on an ongoing basis following enrollment, the applicant or provider shall comply with the following: (1) Ch (relating to general provisions). (2) Applicable Departmental licensure regulations including Chapters 2380, 2390, 5310, 6400, 6500 and (i) Evidence of compliance with applicable licensure regulations is the possession of a valid regular license issued by the Department. (ii) If the applicant possesses a provisional license for a specific HCBS for which the applicant is applying, the applicant is prohibited from enrolling in the HCBSs program. (iii) This paragraph does not prohibit a provider that possesses a provisional license from continuing participation in the HCBSs program once a provider is enrolled. (3) Complete the Department s provider monitoring documentation in accordance with (relating to monitoring compliance) Ongoing provider qualifications. (a) A provider shall comply with the applicable Federally-approved waiver, including the applicable Federally-approved waiver amendments, or the medical assistance state plan as applicable. (b) A provider s qualifications to continue providing HCBSs will be verified at intervals specified in the Federally-approved waiver, including the Federally-approved waiver amendments. (c) The Department may require a provider s qualifications to be verified for continued eligibility at an interval more frequent than the Federally-approved waiver and the Federally-approved waiver amendments due to one of the following: (i) Noncompliance with this chapter as determined by monitoring as specified in (relating to monitoring). 11

12 (ii) Noncompliance with a corrective action plan, or a directed correction action plan, as issued or approved by the administrative entity or the Department. (iii) The issuance of a provisional license by the Department. (iv) Improper enrollment in the HCBS program. (d) Neither a provider, nor its employee who may come into contact with an individual, may be listed on the Federal or Commonwealth lists of excludable persons such as System for Award Management and Medicheck Submission of qualification documentation. A provider shall submit written qualification documentation to the administrative entity or to the Department at least 60 days prior to the expiration of its approved qualification Provision, update and verification of information. A provider shall provide, update and verify information within the Department s information system as part of the initial and ongoing qualification processes Delivery of support. (a) A provider shall deliver only the HCBS for which the provider is deemed qualified by the administrative entity or the Department. (b) A provider shall deliver a HCBS in accordance with the Federally-approved waiver, including the Federally-approved waiver amendments. (c) A provider shall deliver only the HCBS to an individual who is authorized to receive that HCBS from the authorized provider Documentation. An applicant who desires to operate a HCBS in accordance with this chapter must complete and submit the following completed documents and verifications to the Department. (1) A provider enrollment application, on a form specified by the Department. (2) A medical assistance provider agreement, on a form specified by the Department. (3) A home and community-based waiver provider agreement, on a form specified by the Department. (4) Copies of current licenses, if applicable, as specified in (2) (relating to provider requirements). (5) Verification of compliance with (relating to criminal history checks). (6) Verification of compliance with (relating to pre-enrollment training). (7) Documents required in accordance with the Patient Protection and Affordable Care Act (Pub. L. No ). (8) Verification of successful completion of the Department s pre-enrollment training as specified in (relating to pre-enrollment training). TRAINING Annual training plan. (a) The provider shall design an annual training plan based on the needs of the individuals as specified in the person-centered support plans (PSP), the provider s quality management plan and other data and analysis indicating training needs. (b) The annual training plan shall include training aimed at improving the knowledge and skills of the persons to be trained. (c) The annual training plan shall include the following: (1) The title of the position to be trained. 12

13 (2) The required training courses, including training course hours, for each position. (d) Documentation of compliance with the annual training plan shall be kept. (e) A training record for each person trained shall be kept Pre-enrollment training. Prior to applying for participation in the HCBSs program, the applicant shall complete the Department s pre-enrollment provider training Orientation. Prior to working alone with individuals, and within 30 days after hire or starting to provide support, the provider s management, administrative, fiscal, dietary, housekeeping, maintenance, ancillary and direct support staff persons, including full and part time staff persons, family members who will provide reimbursed supports to the individual, volunteers who will work alone with individuals, paid and unpaid interns who will work alone with individuals and consultants who will have direct contact with individuals, shall complete and pass the Department s orientation training course Annual training. (a) The following persons shall complete 24 hours of training each year. (1) Direct support staff persons. (2) Direct supervisors of direct support staff persons. (3) Family members who provide HCBS to the individual. (4) Consultants who provide direct support to individuals. (b) The following persons shall complete 12 hours of training each year. (1) Management, administrative, fiscal, maintenance and ancillary staff persons. (2) Direct support staff persons and supervisors of direct support staff persons who work 20 or fewer hours per week. (3) Consultants who provide direct support to individuals for 20 hours or fewer per week. (4) Consultants who work alone with individuals. (5) Volunteers who provide HCBS and who work alone with individuals. (6) Paid and unpaid interns who work alone with individuals. (c) A minimum of eight of the annual training hours specified in (a) and (b) shall encompass the following areas: (1) The application of the mission, vision and values of person-centeredness; integration; independence; choice and community opportunities for individuals. (2) The prevention, detection and reporting of abuse, suspected abuse and alleged abuse in accordance with 35 P.S (relating to older adult protective services), 23 Pa.C.S (relating to child protective services), Chapter 3490 (relating to protective services), 35 P.S (relating to adult protective services) and applicable adult protective services regulations. (3) Individual rights and choices as specified in (relating to individual rights and choices). (4) Recognizing and reporting incidents. (5) The safe and appropriate use of behavior management procedures, including the use of positive interventions in accordance with (relating to positive interventions), the prohibition of certain restraints in accordance with (relating to prohibition of 13

14 certain restraints) and the appropriate and safe application of manual restraints and exclusion in accordance with (6)-(8), if the person will provide a support to an individual with a challenging behavior. (d) The balance of the annual training hours shall be in areas identified by the provider in the provider s annual training plan in (relating to annual training plan). (e) All training, including those training courses identified in (c) and (d), shall be included in the provider s annual training plan. INDIVIDUAL RIGHTS AND CHOICES Informing and encouraging the exercise of rights and choices. (a) The provider shall inform and explain individual rights and choices to the individual, and persons designated by the individual, upon entry into the program and annually thereafter. (b) Statements signed by the individual, and persons designated by the individual, acknowledging receipt of the information on rights and choices shall be kept Exercise of rights and choices. (a) Each individual shall be continually encouraged to exercise the individual s rights and make choices. (b) Each individual be provided the assistance and accommodation necessary to be able to understand and actively exercise rights and choices. (c) An individual may not be deprived of rights or choices. (d) An individual may not be reprimanded, punished or retaliated against for exercising his rights. (e) A court may restrict the rights of an individual. (f) A court-appointed legal guardian may make choices on behalf of an individual, in accordance with court specifications. (g) An individual who has a court-appointed legal guardian or who has a court order restricting the individual s rights, shall be involved in decision-making to the extent practical and appropriate. (h) An individual has the right to designate persons to make choices and to assist in decisionmaking on behalf of the individual Rights and choices of the individual. (a) An individual may not be discriminated against because of race, color, creed, disability, religious affiliation, ancestry, gender, sexual preference, national origin or age. (b) An individual has the right to civil and legal rights afforded by statute to include the right to vote, freedom of speech and the right to practice the religion of his choice or to practice no religion. (c) An individual may not be abused, neglected, mistreated, abandoned or subjected to corporal punishment. (d) An individual shall be treated with dignity and respect. (e) An individual has the right to make choices and accept risks. (f) An individual has the right to refuse to participate in activities and supports. (g) An individual has the right to control his own schedule. (h) An individual has the right to privacy of person and possessions. (i) An individual has the right to choose a willing and qualified provider. (j) An individual has the right to choose where, when and how to receive needed supports. (k) An individual has the right to voice concerns about the supports the individual receives. 14

15 (l) An individual has the right to participate in the development and implementation of the person-centered support plan. (m) An individual has the right to security of possessions Additional rights and choices of the individual in residential habilitation. (a) An individual has the right to receive scheduled and unscheduled visitors, and to communicate and meet privately with persons of the individual s choice, at any time. (b) An individual has the right to unrestricted access to send and receive mail, unopened by others. (c) An individual has the right to unrestricted and private access to telecommunications. (d) An individual has the right to manage and access his own finances. (e) An individual has the right to choose persons with whom to share a bedroom, if applicable. (f) An individual has the right to furnish and decorate his bedroom and common areas of the home. (g) An individual has the right to lock his bedroom door. (h) An individual has the right to access food at any time. (i) An individual has the right to make health care decisions. PERSON-CENTERED SUPPORT PLAN Development of the person-centered support plan. (a) An individual shall have one, and no more than one, approved and authorized personcentered support plan (PSP) at a given time. (b) The support coordinator shall coordinate the development of the PSP, including revisions, in cooperation with the individual and the individual s supports planning team, in accordance with (relating to support coordination). (c) The initial PSP shall be developed prior to the individual receiving a reimbursed support. (d) The PSP shall be initially developed, revised annually and revised when an individual s needs change, based upon a current assessment. (e) The individual, and persons designated by the individual, shall be involved in and supported in the development and revisions of the PSP. (f) The PSP, including revisions, shall be documented on a form specified by the Department The PSP process. (a) The PSP process shall be directed by the individual. (b) The PSP process shall: (1) Invite and include persons designated by the individual. (2) Provide necessary information and support to ensure that the individual directs the PSP process, to the maximum extent possible. (3) Enable the individual to make informed choices and decisions. (4) Be timely and occur at intervals, times and locations of choice and convenience to the individual and to persons designed by the individual. (5) Reflect cultural considerations of the individual and persons designed by the individual. (6) Be communicated in clear and understandable language. (7) Reflect cultural considerations of the individual (8) Include guidelines for solving disagreements among the PSP team members. (9) Include a method for the individual to request updates to the PSP. 15

16 (10) Record the alternative settings that were considered by the individual Content of the PSP. The PSP, including revisions, shall include the following: (1) The individual s strengths, preferences and functional abilities. (2) The individual s specific and individualized clinical and support needs. (3) Individually identified, person-centered desired outcomes. (4) Supports to assist the individual to achieve desired outcomes. (5) The provider of the support. (6) Natural supports, defined as unpaid supports that are provided voluntarily to the individual in lieu of a reimbursed support. (7) The type, amount, duration and frequency for the support, specified in a manner that reflects the assessed needs and choices of the individual. The schedule of support delivery shall be determined by the PSP team. (8) Communication mode, abilities and needs. (9) Opportunities for new or continued community participation. (10) Risk factors, challenging behaviors and risk mitigation strategies, if applicable. (11) Modification of individual rights as necessary to mitigate risks, if applicable. (12) Health care information, including a health care history. (13) The individual s choice of the provider and setting in which to receive supports. (14) Financial information including how the individual chooses to use personal funds. (15) A back-up plan to provide the needed supports in the event of an emergency or in the absence of the designated support person. (16) The person responsible for monitoring the implementation of the PSP Implementation of the PSP. The PSP, including revisions, shall be implemented as written Support coordination and targeted support management. (a) A support coordinator or targeted support manager shall assure the completion of the following activities when developing an initial PSP and all reviews and revisions of the PSP: (1) Coordination of information gathering and assessment activity, which includes the results from assessments, at least 15 days prior to the initial PSP meeting, and at least 90 days prior to the end date of the PSP for the annual PSP meeting. (2) Collaboration with the individual, persons designated by the individual, the provider and other PSP team members to coordinate a date, time and location for the interim PSP meetings at least 15 days prior to the meeting, and for the annual PSP meeting at least 90 days prior to the end date of the PSP. (3) Distribution of invitations to PSP team members at least 14 days before a PSP meeting is held. (4) Facilitation of the PSP meeting. (5) Obtaining agreement and signatures from the individual, persons designated by the individual and other team members. (6) Documentation and submission of the annual and interim PSP reviews, and revisions to the PSP, to the administrative entity for approval and authorization at least 15 days after an interim PSP meeting and at least 30 days prior to the end date of the annual PSP. (7) If the PSP is returned for revision, resubmission of the amended PSP for approval and authorization within 7 days of the date it was returned for revision. 16

17 (8) Distribution of the PSP to the PSP team members who do not have access to the Department s information management system within 14 days of its approval and authorization, in a manner chosen by the team member. (9) Revision of the PSP when there is a change in an individual s needs. (b) A support coordinator or targeted support manager shall complete an interim review of the PSP, to include the individual, persons designated by the individual and the provider every three months, or more frequently as specified in the individual s PSP. (c) A support coordinator or targeted support manager shall complete a comprehensive review and revision of the PSP, to include the individual, persons designated by the individual, the provider and other PSP team members annually. (d) A support coordinator or targeted support manager who provides support to an individual who receives only support coordination or targeted support management shall meet with the individual and persons designated by the individual to review the PSP annually Documentation of support delivery. (a) Documentation of support delivery related to the individual shall be prepared by the provider, for the purposes of substantiating a claim. (b) The provider shall document support delivery each time a support is delivered. (c) Documentation of support delivery may be made on the same form if multiple supports are provided to the same individual, by the same provider and at the same location. (d) Documentation of support delivery shall include the following: (1) The name of the individual. (2) The name of the provider. (3) The date, name, title and signature of the person completing the documentation. (4) The amount, frequency and duration of the support as specified in the PSP. (5) A summary documenting what support was delivered, who delivered the support, when the support was delivered, where the support was delivered and how much or how long the support was delivered. (6) The outcome of the support delivery. (7) A time-sheet that supports the claim. (e) A copy of the documentation of support delivery shall be kept in the individual s record Access to the community. EMPLOYMENT AND COMMUNITY PARTICIPATION (a) The individual shall have the encouragement and supports necessary to access the community. (b) The individual shall have ongoing opportunities and supports necessary to participate in community activities of his choice. (c) The individual shall have the same degree of community access and choice as an individual who is similarly situated in the community and who does not have a disability to the same degree of access as an individual who does not receive a Medicaid HCBS Opportunities for employment. (a) The individual shall have active and ongoing opportunities and supports to seek and retain employment and work in competitive, integrated settings. 17

18 (b) Placement of an individual who is under 25 years of age into an adult training facility or a vocational facility is permitted only after a referral to the Department of Labor and Industry, Office of Vocational Rehabilitation (OVR) is made and competitive employment opportunities are actively pursued. (c) Each individual shall be offered appropriate opportunities related to the individual s skills and interests, and encouraged to seek competitive employment, at each annual PSP review. (d) The support coordinator or targeted support manager shall provide education and information to the individual about competitive employment and the OVR services Individual choice. TRANSITION (a) Undue influence shall not be exerted by the current or new provider when the individual is considering a transition to a new provider. (b) An individual shall be supported in exercising choice in transitioning to a new provider. (c) An individual s choice to transition to a new provider shall be accomplished in the timeframe desired by the individual, to the extent possible and in accordance with this chapter Transition to a new provider. (a) When an individual transitions to a new provider, both the current and new provider shall cooperate with the Department, the administrative entity and the support coordinator or the targeted support manager, during the transition between providers. (b) The current provider shall ensure the following: (1) Participation in transition planning to aid in the successful transition to the new provider. (2) Arrangement for transportation of the individual to visit to the new provider, if transportation is included in the support. (3) Closing of pending incidents in the Department s information management system Reasons for discharge or transfer. The following are the only grounds for discharge or transfer of an individual against the individual s wishes: (1) The individual is a danger to himself or others, even with the provision of supplemental supports. (2) The individual s needs have changed, advanced or declined so that the individual s needs cannot be met by the provider, even with the provision of supplemental supports. (3) Meeting the individual s needs would require a fundamental alteration of the provider s program or building Written notice. (a) If a provider is no longer able or willing to provide a support for an individual, or if the individual chooses another provider, the provider shall provide written notice to the individual, persons designated by the individual, the PSP team members, the 18

19 Department, the administrative entity and the support coordinator or targeted support manager, at least 30 days prior to the date of the proposed discharge. (b) Subsection (a) does not apply to a hospital discharge following an inpatient hospital admission. (c) The provider s written notice specified in (a) shall include the following: (1) The individual s name and master client index number. (2) The current provider s name and master provider index number. (3) The support that the provider is unable or unwilling to provide or for which the individual chooses another provider. (4) The location where the support is currently provided. (5) The reason the provider is no longer able or willing to provide the support as specified in (relating to reasons for discharge), or, the reason the individual chooses another provider. (6) A description of the efforts made to address or resolve the issue that has led to the provider becoming unable or unwilling to provide the support or for which the individual chooses another provider. (7) Suggested time frames for transitioning the delivery of the support to the new provider Continuation of supports. A provider shall continue to provide the authorized support during the transition period to ensure continuity of care until a new provider is approved by the Department, unless otherwise directed by the Department or the administrative entity Health and safety risk. A provider shall provide written notification to the Department and the administrative entity immediately if the provider is no longer able to provide a HCBS due to an immediate health and safety risk to the individual Support coordination. The support coordinator or targeted support manager shall coordinate the transition planning activities including managing, scheduling and participating in all transition planning meetings during the transition period Transition of records. (a) The previous provider shall transfer the original individual records to the new provider one day before the date of transfer. (b) The previous provider shall maintain a copy of the individual records in accordance with (relating to recordkeeping) Positive interventions. SAFE BEHAVIOR MANAGEMENT (a) Positive interventions, such as environmental changes, improved communications, reinforcing appropriate behavior, recognizing and treating physical and mental health 19

20 symptoms, voluntary physical exercise and other wellness practices, redirection, praise, modeling, conflict resolution and de-escalation, shall be used to prevent, manage and modify a challenging behavior. (b) The least restrictive method shall be applied when managing a challenging behavior. For each incidence of a challenging behavior, every attempt shall be made to anticipate, prevent and de-escalate a challenging behavior using methods of intervention less intrusive than the use of restraints. (c) A restraint may never be used as a behavioral intervention, consequence, retribution, punishment, for the convenience of staff persons or as a substitution for program Person-centered support plan. If the individual has a challenging behavior as identified in the PSP, the PSP shall include the following: (1) The specific challenging behavior to be addressed and the suspected antecedent or function of the behavior. (2) The behavioral outcome desired stated in measurable terms. (3) A description of the positive interventions aimed at preventing, modifying or eliminating the challenging behavior and the circumstances under which the interventions are to be used. (5) A target date for achieving the outcome. (6) The amount of time the intervention or procedure may be applied, not to exceed the maximum time periods specified in this chapter. (7) Physical or health conditions that require special attention during the use of restrictive procedures. (8) The name of the position responsible for monitoring and documenting progress with the plan Prohibition of certain restraints. The following procedures are prohibited: (1) Seclusion, defined as involuntary confinement of an individual in a room or area from which the individual is physically prevented from leaving. (2) Aversive conditioning, defined as the application of startling, painful or noxious stimuli. (3) Pressure point techniques, defined as the application of pain for the purpose of achieving compliance. (4) A chemical restraint, defined as use of drugs or chemicals for the specific and exclusive purpose of controlling acute or episodic aggressive behavior. A chemical restraint does not include a drug ordered by a physician or dentist to treat the symptoms of a specific mental, emotional or behavioral condition, or as pretreatment prior to a medical or dental examination or treatment. (5) A mechanical restraint, defined as a device that restricts the movement or function of a resident or portion of an individual s body. Mechanical restraints include a geriatric chair, handcuffs, anklets, wristlets, camisole, helmet with fasteners, muffs and mitts with fasteners, posey, waist straps, head straps, papoose board, restraining sheets, chest restraint and other types of locked restraints. A mechanical restraint does not include a device used to provide support for the achievement of functional body position, to provide post-surgical care or to provide proper balance that has been prescribed by a medical professional, as long as the individual can easily remove the device. (6) A manual restraint, defined as a hands-on physical means that restricts, immobilizes or reduces an individual s ability to move his arms, legs, head or other body parts freely, for a period of more than 30 minutes within a 2-hour period. A manual restraint does not include 20