Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 05 - Developmental Disabilities Services › Rule 016.05.17-005 - DDS Community and Employment Supports (CES) Waiver and Medicaid Provider Manual #2-17

Current through Register Vol. 49, No. 6, June, 2024
Application for a §1915(c) Home and Community-Based
				Services Waiver
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200.000
DDS COMMUNITY EMPLOYMENT SUPPORTS (CES) WAIVER GENERAL INFORMATION
201.000
Arkansas Medicaid Program
			 Participation Requirements for DDS CES Waiver Program
All Division of Developmental Disabilities Services (DDS)
				Community and Employment Supports (CES) waiver providers must meet the provider
				participation and enrollment requirements contained within Section 140.000 of
				this manual as well as the following criteria to be eligible to participate in
				the Arkansas Medicaid Program:
Medicaid will accept electronic signatures provided the
				electronic signatures comply with Arkansas Code §
											25-31-103
				et seq.
All willing and qualified providers have the opportunity
				to enroll as a waiver provider. DDS provides continuous open enrollment for
				waiver service providers. Potential providers should contact DDS Quality
				Assurance staff for information on the CES certification standards. Once a
				provider is certified by DDS. the provider must contact the DMS Provider
				Enrollment Unit to enroll as a Medicaid provider.
Certified and enrolled providers are allowed to specify
				the maximum number of persons they can serve, the county they can sen/e, the
				services they can provide and the service levels they can offer based on staff
				availability. Waiver beneficiaries have the freedom of choice of service
				providers. Once a provider is chosen by a beneficiary and meets the
				designations made by the provider, the provider cannot refuse to provide
				services unless the provider cannot assure the health and safety of the
				beneficiary. It is incumbent upon the provider to prove the individual cannot
				be served by the provider. The burden of proof also requires written
				identification of the cause for the failure to provide health and safety
				supported by documentation that attests to that condition.
Before a provider can decrease the maximum number of
				beneficiaries they will serve, drop an existing county they serve, a service,
				or service level, the provider must identify any beneficiary cun-ently being
				served who would be affected. The provider will be required to continue
				providing services to any beneficiary who would be affected by the changes
				until such time as DDS can secure a new provider and services are in place
				under the new provider. If a provider elects to change the existing county
				served or the maximum number of participants served, the change cannot be made
				if it will adversely impact any beneficiary currently receiving services from
				the provider. The provider's maximum number of beneficiaries served may only be
				reduced through ceasing provision of services in a designated county or
				counties, freezing the number of persons they serve at the current number and
				reducing the number through attrition, or ceasing provision of services to
				those beneficiaries they have most recently begun sen/ing. DDS will freeze new
				referrals when a provider requests to make changes in the above items but will
				not approve the changes for existing beneficiaries until such time as the
				transition to a new provider has occurred. Further, when less than an
entire
county is deleted from coverage, the
				provider must articulate in writing a business reason for making the change and
				demonstrate that the selection process is not capricious or arbitrary, does not
				result in discrimination and does not unfairly distinguish between levels of
				care. The process cannot be used to eliminate difficult families or
				beneficiaries. Other than business reasons for closing entire counties or
				programs, beneficiaries can only be discontinued if the provider cannot assure
				health and safefy.
Option: Based on individual choice, a provider may
				continue to serve a beneficiary without serving others in the county when the
				individual served relocates their place of residence.
201.100
Providers of DDS CES Waiver
			 Services in Arkansas and Bordering
States Trade Area Cities
DDS CES waiver services are limited to Arkansas and
				bordering state trade area cities. The DOS must certify providers located in a
				bordering state trade area city as CES v/aiver providers before services may be
				provided for Arkansas Medicaid beneficiaries.
Bordering state trade area cities are Monroe and
				Shreveport, Louisiana; Clari[LESS THAN]sdale and Greenville, Mississippi;
				Poplar Bluff and Springfield, Missouri; Poteau and Sallisaw, Oklahoma; Memphis,
				Tennessee and Texarikana, Texas.
201.200
Organized Health Care Delivery
			 System Provider
The DDS CES waiver allows a provider who is licensed and
				certified as a DDS CES case management entity or a DDS CES supportive living
				services provider to enroll in the Ari[LESS THAN]ansas Medicaid Program as a
				DDS CES organized health care delivery system (OHCDS) provider.
The option of OHCDS is available to any cunrent or future
				provider through a written agreement between DDS and the provider entity. The
				agreement requires each OHCDS provider to guarantee that any sub-contractor
				will abide by all Medicaid regulations and provides that the OHCDS provider
				assumes all liability for contract noncompliance. The OHCDS provider must also
				have a written contract that sets forth specifications and assurances that work
				will be completed timely, satisfactorily to the beneficiary being sen/ed and
				with quality maintained. The OHCDS provider is responsible for ensuring that
				services were delivered and proper documentation, including a signed customer
				satisfaction statement, has been submitted prior to billing.
As long as the OHCDS provider delivers at least one
				waiver service directly utilizing its own employees, an OHCDS provider may
				provide any other DDS CES waiver service via a subcontract with an entity
				qualified to fumish the service. The subcontract must ensure financial
				accountability and that services were delivered, property documented and
				billed. The primary use of OHCDS is consultation, adaptive equipment,
				environmental modifications, supplemental support and specialized medical
				supplies.
The OHCDS provider furnishes the sen/ices as the
				beneficiary's provider of choice as described in that beneficiary's
				person-centered service plan
202.000
Documentation
			 Requirements
DDS CES waiver providers must keep and property maintain
				written records. Along with the required enrollment documentation, which is
				detailed in Section 141.000, the follovwng records must be included in the
				beneficiary's case files maintained by the provider.
202.100
Documentation in Beneficiary's
			 Case Files
DDS CES waiver providers must develop and maintain
				sufficient written documentation to support each sen/ice for which billing is
				made. This documentation, at a minimum, must consist of:
A.
A copy of the beneficiary's
			 person-centered service plan, including any amendments
			 thereto.
B.
The
			 specific services rendered.
C.
The date and actual time the
			 services were rendered.
D.
The name of the individual who provided the service.
E.
The relationship of the sen/ice to
			 the treatment regimen of the beneficiary's person-centered service
			 plan.
F.
Updates
			 describing the beneficiary's progress or
lack
thereof. Updates should be maintained on a daily basis or at
			 each contact with or on behalf of the beneficiary. Progress notes must be
			 signed and dated by the provider of the service.
G.
Certification statements,
			 narratives and proofs that support the cost-effectiveness and medical necessity
			 of the service to be provided.
Additional documentation and information may be required
				dependent upon the service to be provided.
202.200
HCBS Settings
			 Requirements
Home and Community-Based Services (HCBS)
				Settings
All providers must meet the following Home and
				Community-Based Services (HCBS) Settings regulations as established by CMS. The
				federal regulation for the new mle is
				42 CFR 441.301(c)
				(4)-(5).
Settings that are HCBS must be integrated in and support
				full access of beneficiaries 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 beneficiaries not
				receiving Medicaid HCBS.
HCBS settings must have the following
				characteristics:
A.
Chosen by the individual from among setting options including
			 non-disability-specific settings (as well as an independent setting) and an
			 option for a private unit in a residential setting.
1.
Choice must be included in the
			 person-centered service plan.
2.
Choice must be based on the
			 individual's needs, preferences and, for residential settings, resources
			 available for room and board.
B.
Ensures an individual's rights of
			 privacy, dignity and respect and freedom from coercion and restraint.
C.
Opimizes, but does not
			 regiment, individual initiative, autonomy and independence in making life
			 choices, including but not limited to, daily activities, physical environment,
			 and with whom to interact.
D.
Facilitates individual choice regarding services and supports and who
			 provides them.
F.
In a
			 provider-owned or -controlled residential setting (e.g.. Group Homes), in
			 addition to the qualities specified above, the following conditions must be
			 met:
1.
The unit or dwelling is
			 a specific physical place that can be owned, rented, or occupied under a
			 legally enforceable agreement by the individual receiving services, and the
			 Individual has, at a minimum, the same responsibilities and protections from
			 eviction that tenants have under the landlord/tenant law of the State, county,
			 city, or other designated entity. For settings in which landlord/tenant laws do
			 not apply, the State must ensure that a lease, residency agreement or other
			 form of written agreement will be in place for each HCBS participant and that
			 the document provides protections that address eviction processes and appeals
			 comparable to those provided under the jurisdiction's landlord/tenant
			 law.
2.
Each
			 individual has privacy in their sleeping or living unit:
a.
Units have entrance doors lockable
			 by the individual, with only appropriate staff having keys to
			 doors.
b.
Beneficiaries sharing units have a choice of roommates in that
			 setting.
c.
Beneficiaries have tlie freedom to fumisfi and decorate their sleeping or
			 living units within the lease or other agreement.
3.
Beneficiaries have the freedom and
			 support to control their
own
schedules and
			 activities and have access to food at any time.
4.
Beneficiaries are able to have
			 visitors of their choosing at any time.
5.
The setting is physically
			 accessible to the individual.
6.
Any modification of the additional
			 conditions specified in items 1 through 4 above must be supported by a specific
			 assessed need and justified in the person-centered service plan. The following
			 requirements must be documented in the person-centered service plan:
a.
Identify a specific and
			 individualized assessed need.
b.
Document the positive interventions
			 and supports used prior to any modifications to the person-centered service
			 plan.
c.
Document
			 less intrusive methods of meeting the need that have been tried but did not
			 work.
d.
Include a
			 clear description of the condition that is directly proportionate to the
			 specific assessed need.
e.
Include regular collection and review of data to measure the ongoing
			 effectiveness of the modification.
f.
Include established time limits for
			 periodic reviews to determine if the modification is still necessary or can be
			 terminated.
g.
Include the informed consent of the individual.
h.
Include an assurance that
			 Interventions and supports will cause no harm to the
			 individual.