9036 REMOTE SUPPORTS SERVICES

9036.1 Remote supports services are the provision of supports by staff of a certified provider at a remote location or through an electronic method of service delivery who are engaged with individual(s) through equipment with the capability for live two-way communication. Equipment rental/purchase shall be through assistive technology services. Equipment used to meet this requirement shall include one or more of the following components:

1. (a) Motion sensing system;
2. (b) Radio frequency identification;
3. (c) Live video feed;
4. (d) Live audio feed;
5. (e) Web-based monitoring system;
6. (f) Sensor detection monitoring systems;
7. (g) Another device that facilitates live two-way communication; or
8. (h) Other devices that may effectively facilitate therapy services.

9036.2 Remote supports services shall be provided in real time, not via a recording, by staff who are at a Monitoring Base using the appropriate connection. While remote supports are being provided, the remote supports staff shall not have duties other than remote supports.

9036.3 Remote supports services are available through the following Home and Community-Based Services (HCBS) waiver services:

1. (a) Behavioral Support Services;
2. (b) Creative Arts Therapies Services;
3. (c) Day Habilitation Services;
4. (d) Employment Readiness Services;
5. (e) Family Training Services;

(f) Occupational Therapy Services;

(g) Parenting Supports Services;

(h) Speech, Hearing, and Language Services;

(i) Supported Employment Services; and

(j) Wellness Services, including bereavement counseling, fitness training, nutrition evaluation/consultation services, and sexuality education.

9036.4 Remote supports services are intended to address a person's assessed needs and promote autonomy, maintain or improve functional abilities, enhance interactions, support meaningful relationships, and promote independent living and meaningful participation in the community.

9036.5 The remote supports services caregiver can interact, coordinate supports, monitor, and/or respond to the person's needs through equipment capable of live two-way communication.

9036.6 Remote supports services shall be delivered in the following four (4) delivery models:

(a) Active Support: real-time observation of the monitoring system during scheduled times. The remote caregiver monitors the system in real-time and responds immediately as needed;

(b) On-Demand Active Support: real-time observation of the monitoring system only when needed. This type of "as needed" live real-time support is started when a triggering event occurs (from a sensor of some type), indicating the need for support;

(c) Scheduled Check-in: a remote caregiver checks-in with the person at scheduled times. These are typically centered around activities of daily living or can be a simple wellness check; and

(d) Drop-in: a remote caregiver checks-in at random times to ensure the wellness of the person supported to determine if they need any assistance.

9036.7 The Service Coordinator, in consultation with the person and their team, shall assess whether remote supports are sufficient to ensure services are delivered in a person-centered manner that ensures their health and welfare. If it is determined that in-person assistance is required, remote supports may not be provided.

9036.8 A person who requires in-person assistance during the provision of a service shall receive services in-person and not through remote supports.9036.9 The person's support team shall complete the Person-Centered Support Tool to identify support needs, preferences, outcomes, and technology solutions and determine whether:- (a) The person is equipped to receive remote supports services; and

- (b) The extent to which remote services should be received.9036.10 Informed consent shall be given by the person who receives remote supports services or their authorized representative.9036.11 Remote supports involving the use of audio or video equipment that permits remote supports staff to view activities or listen to conversations in the residence shall not be provided until the person who receives the service, or their authorized representative, and each person who lives with the individual:- (a) Is fully informed of what remote supports entail including, but not limited to, that the remote supports staff will observe their activities and/or listen to their conversations in the residence, where in the residence the remote supports will take place, and whether or not recordings shall made; and

- (b) Has given written consent to the provision of remote support services, as described in paragraph (a), in their residence. The service coordinator and provider shall keep copies of the signed consent forms with the person's Individual Service Plan (ISP).9036.12 Remote supports services staff shall have written protocols for responding to a person's needs as specified in the ISP, including contact information for the on-call support person to provide assistance when necessary and times when remote supports will be provided. The ISP shall set forth the protocol to be followed should the individual request that the equipment used for delivery of remote supports be turned off.9036.13 Required remote supports content in the ISP must include the following:- (a) Justification statement that:

- (1) Explains how remote supports benefit the person, promote independence, assist in outcome achievement and, assure health and safety; and

1. (2) Justifies the need for any other service such as the need for Assistive Technology services for the purposes to acquire Equipment rental/purchase; and
2. (3) Supports the need for remote services and identifies a percentage of services to be delivered through remote supports, not to exceed service caps under the approved IDD Waiver.- (b) A description of the person's preferences and how the delivery of remote supports will reflect the person's preferences. This should reflect the utilization of person-centered tools and exhibit how support strategies have been developed to meet the person's preferences;
3. (c) Verification that a risk assessment was completed and reviewed through the utilization of the person's person-centered tools and other assessment results by the support team to ensure the appropriate technology solutions and support strategies have been identified to address any risk areas;
4. (d) A description of the required remote supports equipment function, purpose, features, general location in the home, and the person's and their family's knowledge of how to use equipment (e.g., turn on and off, how to request assistance remotely, etc.);
5. (e) A description of initial and ongoing training strategies for the person supported, support staff, and family members, if applicable;
6. (f) A description of a defined 30-day trial period where the person supported will still receive direct supports while receiving remote supports services to ensure the established support strategies are effective, and meet their support needs and preferences;
7. (g) A schedule of when remote supports services will be provided and the delivery model for the provision of remote supports (e.g., Active Support, Active On-Demand, Check-in Scheduled, Check-in Random);
8. (h) A description of a back-up plan in the event of system failure (e.g., equipment malfunction, power outage), including a detailed emergency/on-call response plan in the event the person needs a paid in-person response to their residence. The emergency response plan can include natural supports or paid supports. The detailed plan for response at the person's residence or location covered by remote supports should include at a minimum a description of:

(1) Response times defined by the person’s support team. In

situations requiring a person to respond to a person's residence, the response time should not exceed thirty (30) minutes;

(2) Response type(s), including face-to-face and/or telephone, depending on how to optimally respond to the supported person's particular need at that time to ensure health and safety;

(3) Procedure for the remote supports vendor and/or caregiver to notify emergency personnel such as police, fire, emergency medical services, and psychiatric crisis response entities during an emergency; and

(4) Documentation requirements for an emergency event as outlined by Incident Reporting policy.

9036.14 Remote supports services shall be provided by a certified provider that has a current District of Columbia Medicaid Provider Agreement and meets the following requirements:

(a) Shift training to include Enabling Technology Credential (ETC) and/or Enabling Technology Integration Specialist (ETIS);

(b) Operation of the Remote Support Monitoring Base systems;

(c) Provider Training Phase I, II, and III as described online at https://dds.dc.gov/page/dds-training-institute with the exemption of Cardiopulmonary resuscitation (CPR) and Trained Medication Employee (TME); and

(d) Comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), as amended by the Health Information Technology for Economic and Clinical Health (HITECH) Act, and their applicable regulations to protect the privacy and security of the participant's protected health information.

9036.15 The remote supports provider/vendor shall provide initial and ongoing training to its staff to ensure they know how to use the monitoring base system.

9036.16 The remote supports provider/vendor shall provide an individual who receives remote supports services with initial and ongoing training on how to use the remote supports system as specified in the ISP.

9036.17 A monitoring base shall not be located at the residence of a person who receives remote supports services.

9036.18 Participant privacy rights and obligations shall be assured and monitored on an ongoing basis.

9036.19 Video or remote support devices shall not be used or placed in participant bedrooms or bathrooms.

9036.20 A secure network system requiring authentication, authorization, and encryption of data in accordance with 45 C.F.R. Part 164, Subpart A shall be in place to ensure that access to computer, video, audio, sensor, and written information is limited to authorized persons.

9036.21 Service documentation for remote supports services shall include each of the following to be eligible for Medicaid reimbursement:

(a) Type of service;

(b) Date of service;

(c) Place of service;

(d) The use of remote supports services must be documented appropriately, just as any in-person direct supports, and identify the service delivery method of service (e.g. Skype™, Zoom®, Facetime®, etc.);

(e) Start and end time of service;

(f) Name of individual receiving the service;

(g) Medicaid identification number of individual receiving service;

(h) Name of provider;

(i) Name of staff person providing service;

(j) Provider identifier/contract number;

(k) Start and end time of the remote supports services when the on-call support person is needed on site;

(l) Written or electronic signature of the person delivering the service, or initials of the person delivering the service if a signature and corresponding initials are on file with the provider;

(m) Number of units of the delivered service per calendar year; and

1. (n) Description and details of the services delivered that directly relate to the services specified in the approved ISP as the services to be provided.9036.22 Provider documentation when delivering remote supports services shall include the following to be eligible for Medicaid reimbursement services:- (a) Daily notes to verify service provision;
2. (b) Start and end times;
3. (c) Indication if the period during service delivery was uneventful (e.g., “no response needed”);
4. (d) If, for example, a sensor alerts the remote caregiver staff, describe the occurrence that activated the sensor, when it happened, who was involved, response, and outcome;
5. (e) Description of any communication between remote caregiver staff and person supported;
6. (f) Staff attendance logs with staff initials for the time segments each was directly involved in providing remote supports during that time frame, if applicable;
7. (g) Provider quarterly report; and
8. (h) Complete any incident reports as applicable to DDS Incident Management Policy.9036.23 A person approved for remote supports services shall be issued a separate service authorization indicating the frequency of usage.9036.24 Per the approved IFS waiver, none of the remote supports services can be provided remotely one hundred (100) percent of the time.9036.25 A hybrid model may be used for in-person and remote supports service hours where two (2) service authorizations are issued to cover the in-person service hours and the remote supports service hours.9036.26 When a person receives remote supports services with on-call support, the remote supports provider shall bill for the remote supports and provide the remote supports directly or through a contract with a remote supports vendor that meets the requirements of this rule. In the event that the remote supports staff contacts the remote supports provider to request emergency or in-person assistance, the paid on-

call support person's time shall be included in the rate for remote supports services.

9036.27 The following HCBS waiver services delivered through remote supports services shall maintain the same reimbursement rates as in-person services:

1. (a) Behavioral Support Services;
2. (b) Creative Arts Therapies Services;
3. (c) Family Training Services;
4. (d) Occupational Therapy Services;
5. (e) Parenting Support Services;
6. (f) Speech, Hearing, and Language Services;
7. (g) Supported Employment Services; and
8. (h) Wellness Services, including bereavement counseling, fitness training, nutrition evaluation/consultation services, and sexuality education.

9036.28 An individual providing remote support services shall meet the following requirements:

1. (a) Be at least eighteen (18) years of age;
2. (b) Possess a high school diploma, Certificate of Individual Educational Program (IEP) Completion, general educational development (GED) certificate, or, if the person was educated in a foreign country, its equivalent;
3. (c) Complete pre-service and in-service training as described in DDS policy;
4. (d) Be able to communicate with the person to whom services are provided;
5. (e) Be able to read, write, and speak the English language, with reasonable accommodation as appropriate, in accordance with the Americans with Disabilities Act;
6. (f) Participate in competency-based training needed to address the unique support needs of the person, as detailed in his or her ISP;
7. (g) Provided that they are not licensed pursuant to any of the provisions of law codified at Chapter 12 of Title 3 of the D.C. Official Code and are not

working under the direct supervision of such a person, present proof of compliance with the Health-Care Facility Unlicensed Personnel Criminal Background Check Act of 1998, effective April 20, 1999 (D.C. Law 12-238; D.C. Official Code § 44-551 et seq., as amended; and

(h) Be acceptable to the person to whom services are provided.

SOURCE: Final Rulemaking published at 71 DCR 010475 (August 23, 2024).