1916 IN-HOME SUPPORTS SERVICES

1916.1 In-home supports services shall be reimbursed by the District of Columbia Medicaid Program for each participant with mental retardation and developmental disabilities in the Home and Community-based Services Waiver for Persons with Mental Retardation and Developmental Disabilities (Waiver) subject to the requirements set forth in this section.1916.2 A person shall only be eligible for in-home supports services when living in one of the following types of residences:- (a) His or her own home;

- (b) The person's family home; or,

- (c) The home of an unpaid caregiver.1916.3 In-home supports services provide periodic support to assist the primary caregiver and/or enable the person to live independently and participate in community activities to the fullest extent possible.1916.4 In-home supports services include a combination of hands-on care, habilitative support, and assistance with activities of daily living. In-home supports services eligible for reimbursement shall be as follows:- (a) Training and support in activities of daily living and independent living skills;

- (b) Assistance in performing personal care tasks;

- (c) Assistance with light household tasks specific to the needs of the person;

- (d) Assistance with homemaking tasks such as food preparation and laundering clothes that are specific to the needs of the person;

- (e) Training and support on understanding and utilizing community resources;

- (f) Training on, and assistance in the monitoring of health, nutrition, and physical condition;

- (g) Training and support in adapting to a community and home environment, including management of financial and personal affairs, and awareness of health and safety precautions; and

- (h) Coordinating transportation to community events.1916.5 In-home supports services shall not be used to provide supports that are normally provided by medical professionals.1916.6 In-home supports services shall be authorized by the person's interdisciplinary team and provided in accordance with each person's individual habilitation plan (IHP) or individual support plan (ISP) and Plan of Care.1916.7 In-home supports services require an In-Home Supports Services Plan (Plan) prior to the initiation of services. A copy of the Plan shall be maintained where services are delivered, at the provider's main office, and with the Department on Disability Services (DDS) Case Manager. The Plan will detail:

(a) Activities and supports that will be provided and identify anticipated outcomes;

(b) A staffing plan and schedule;

(c) As necessary, the participation of professionals to meet the person's individual needs; and

(d) Emergency and contingency plans to address potential behavioral, health or emergency events.

1916.8 Each provider of in-home supports services shall be a social services agency as described in Chapter 9 of Title 29 (Public Welfare) of the District of Columbia Municipal Regulations (DCMR), Section 1903.1. In addition, the provider agrees to:

(a) Be a member of the resident's interdisciplinary team;

(b) Have a current District of Columbia Medicaid Provider Agreement that authorizes the provider to bill for In-Home Supports Services under the Waiver;

(c) Maintain a copy of the most recent IHP or ISP and Plan of Care that has been approved by DDS for each person;

(d) Ensure that all in-home support services staff are prepared to facilitate interpreters for non-English speaking persons;

(e) Ensure that the service provided is consistent with the person's IHP or ISP and Plan of Care;

(f) Offer the Hepatitis B vaccination to each person providing services pursuant to these rules;

(g) Provide staff training in infection control procedures consistent with the standards established by the Federal Centers for Disease Control and Prevention; and

(h) Ensure compliance with DDS policies governing reporting of unusual incidents, human rights, behavior management, and protection of person's funds.

1916.9 Each person providing in-home supports services shall meet all of the requirements in Chapter 19 to Title 29 of the District of Columbia Municipal Regulations (DCMR), section 1911 in addition to the requirements set forth below:

(a) Complete competency based training in communication with people with intellectual disabilities;

(b) Complete competency based training in emergency procedures; and

(c) Be certified annually in cardiopulmonary resuscitation (CPR) and First Aid.

1916.10 Each provider of in-home supports services shall maintain progress notes on a weekly basis, or more frequently if indicated, on the IHP or ISP and Plan of Care. The provider shall also maintain current financial records of expenditures of private funds for each person if applicable. Progress notes shall include at a minimum: (a) progress in meeting each goal in the ISP assigned to the in-home supports services provider; (b) list of all community activities the person participates in with the in-home supports provider and the person's response to each activity; (c) any unusual health events, side effect to medication, change in health status, behavioral event, use of a restrictive procedure or unusual incident; (d) any visitor the person receives, special events, and

any situation or event requiring follow-up during the delivery of the in-home supports services; and the dates and times services are delivered.

1916.11 Each provider of in-home supports services shall review the person's IHP or ISP and Plan of Care goals, objectives and activities at least quarterly and more often as needed. The provider shall propose modifications to the IHP or ISP and Plan of Care as appropriate. The results of these reviews shall be submitted to the person's DDS Case Manager within 30 days of the end of each quarter (i.e. by January 30th, April 30th, July 30th, and October 30th).

1916.12 The reimbursement rate shall be twenty dollars and sixty cents ($20.60) per hour billable in units of fifteen minutes at a rate of five dollars and fifteen cents ($5.15), and shall not exceed eight (8) hours per 24-hour day. A fifteen minute unit requires a minimum of eight (8) minutes of continuance service to be billed. Reimbursement shall be limited to those time periods in which the provider is rendering services directly to the person. Each provider of in-home supports services shall assist the primary caregiver and/or participant with the coordination of the delivery of necessary day/vocational program, behavioral support, skilled nursing, transportation, and other required services from approved Waiver providers of those services in accordance with the requirements of the IHP or ISP and Plan of Care and the Plan. DDS may authorize an increase in hours in the event of a temporary emergency need for which there is no other resource available or demonstrated need based on the DDS-authorized utilization process.

1916.13 Reimbursement for in-home supports services shall not include:

(a) Room and board costs;

(b) Routine care and general supervision normally provided by the family or natural caregivers;

(c) Services or costs for which payment is made by a source other than Medicaid; or

(d) Travel or travel training to Supportive Employment, Day Habilitation or Pre-Vocational Services.

1916.14 In-home supports services may be used in combination with Medicaid State Plan Personal Care and Home Health Services so long as the services are not provided during the same period of the day.

1916.15 In-home supports services are not available to participants receiving Host Home, Residential Habilitation or Supported Living Services.

1916.99 DEFINITIONS

When used in this section, the following terms and phrases shall have the meanings ascribed:

Family - Any individual related to the person by blood, marriage or adoption.

Individual Habilitation Plan (IHP) - That plan as set forth in section 403 of the Mentally Retarded Citizens Constitutional Rights and Dignity Act of 1978, effective March 3, 1979 (D.C. Law 2-137; D.C. Official Code § 7-1304.03).

Individual Support Plan (ISP) - The successor to the individual habilitation plan (IHP) as defined in the 2001 Plan for Compliance and Conclusion of Evans v. Williams.

In-Home Supports Services Plan - That plan required by these rules prior to the initiation of services which details the activities and supports that will be provided and identify anticipated outcomes; a staffing plan and schedule; as necessary, the participation of professionals to meet

the person's individual needs; and emergency and contingency plans to address potential behavioral, health or emergency events.

Interdisciplinary Team - A group of persons with special training and experience in the diagnosis and habilitation of mentally retarded persons who have the responsibility of performing a comprehensive person evaluation while participating in the development, implementation, and monitoring of the person's IHP or ISP and Plan of Care.

Person or Participant - An individual with intellectual and developmental disabilities who has been determined eligible to receive services under the Home and Community-based Services Waiver for Persons with Mental Retardation and Developmental Disabilities (Waiver).

Plan of Care - A written service plan that meets the requirements set forth in section 1904.4 of Title 29 DCMR, is signed by the person receiving services, and is used to prior authorize Waiver services.

Provider - Any non-profit, home health agency, social service agency or other business entity that provides services pursuant to these rules.

Waiver - Shall mean the Home and Community-based Services Waiver for Persons with Mental Retardation and Developmental Disabilities as approved by the Council of the District of Columbia (Council) and the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS), as may be further amended and approved by the Council and CMS.

SOURCE: Final Rulemaking published at 55 DCR 2896 (March 21, 2008).