Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.09-041 - DDS Alternative Community Services Waiver Provider Manual Update # 120

Current through Register Vol. 49, No. 6, June, 2024
Section II
DDS Alternative Community Services (ACS) Waiver
201.000
Arkansas Medicaid Program
			 Participation Requirements for DDS ACS Waiver Program
All Division of Developmental Disabilities Services (DDS)
				Alternative Community Services (ACS) waiver providers must meet the enrollment
				criteria detailed in Section 1, subsection 141.000 in order to participate in
				the Arkansas Medical Assistance (Medicaid) program.
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 ACS certification standards. Once a provider is
				certified by DDS, the provider may 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 serve, 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 who 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 persons
				they will serve, drop an existing county they serve, a service, or service
				level, the provider must identify any beneficiary currently being served that
				would be affected. The provider will be required to continue providing services
				to any persons that 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
				person currently receiving services from the provider. The provider's maximum
				number of persons served may only be reduced through attrition. DDS will freeze
				new referrals when a provider requests to make changes in the above items but
				will not approve the changes for existing persons until such time as the
				transition has occurred to a new provider. 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 persons. Other than business reasons
				for closing entire counties or programs, people can only be discontinued if the
				provider cannot assure health and safety.
Option: Based on individual choice, a provider may continue to
				serve a person without serving others in the county, when the individual served
				relocates their place of residence.
201.100
Providers of DDS ACS Waiver
			 Services in Arkansas and Bordering States Trade Area Cities
DDS ACS waiver services are limited to Arkansas and bordering
				state trade area cities. The DDS must certify providers located in a bordering
				state trade area city as ACS waiver providers before services may be provided
				for Arkansas Medicaid beneficiaries.
Bordering state trade area cities are Monroe and Shreveport,
				Louisiana; Clarksdale and Greenville, Mississippi; Poplar Bluff and
				Springfield, Missouri; Poteau and Sallisaw, Oklahoma; Memphis, Tennessee and
				Texarkana, Texas.
201.200
Organized Health Care Delivery System Provider
The DDS ACS waiver allows a provider who is licensed and
				certified as a DDS ACS case management entity or a DDS ACS supportive living
				services provider to enroll in the Arkansas Medicaid Program as a DDS ACS
				organized health care delivery system (OHCDS) provider.
The option of OHCDS is available to any current 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 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 ACS waiver service via a sub-contract with an entity qualified to
				furnish the service. The primary use of OHCDS is consultation, adaptive
				equipment, environmental modifications, supplemental support and specialized
				medical supplies.
The OHCDS provider furnishes the services as the beneficiary's
				provider of choice as described in that beneficiary's person centered service
				plan
202.000
Documentation Requirements
DDS ACS waiver providers must keep and properly maintain
				written records. Along with the required enrollment documentation, which is
				detailed in Section 1, subsection 141.000, the following records must be
				included in the beneficiary's case files maintained by the provider.
202.100
Documentation in
			 Beneficiary's Case Files
DDS ACS waiver providers must develop and maintain sufficient
				written documentation to support each service for which billing is made. This
				documentation, at a minimum, must consist of:
A. A copy of the beneficiary's person
			 centered service plan
B. The
			 specific services rendered
C. The
			 date, and actual time, the services were rendered
D. The name and title of the individual who
			 provided the service
E. The
			 relationship of the service 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. Completed forms as
			 required by DDS
H. 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.
211.000
Scope
The Medicaid program offers certain home and community based
				services (HCBS) as an alternative to institutionalization. These services are
				available for eligible beneficiaries with a developmental disability who would
				otherwise require an intermediate care facility for the mentally retarded
				(ICF/MR) level of care. This waiver does not provide education or therapy
				services.
The purpose of the ACS waiver is to support beneficiaries of
				all ages who have a developmental disability, meet the institutional level of
				care, and require waiver support services to live in the community and thus
				preventing institutionalization.
The goal is to create a flexible array of services that will
				allow people to reach their maximum potential in decision making, employment
				and community integration; thus giving their lives the meaning and value they
				choose.
The objectives are as follows:
A. To transition eligible persons who choose
			 the waiver option from residential facilities into the community;
B. To provide priority services to persons
			 who meet the pervasive level of service (imminent danger and requiring supports
			 24 hours a day, seven days a week); and
C. To enhance and maintain community living
			 for all persons participating in the waiver program.
DDS is responsible for day-to-day operation of the waiver. All
				waiver services are accessed through DDS Adult Services, DDS Children's
				Services or the ICF/MR services intake and referral staff.
All ACS waiver services must be prior authorized by DDS. All
				services must be delivered based on the approved person centered service
				plan.
Waiver services will not be furnished to persons while they are
				inpatients of a hospital, nursing facility (NF), or ICF/MR unless payment to
				the hospital, NF, or ICF/MR is being made through private pay or private
				insurance.
A person may be placed in abeyance in three month increments
				(with status report every month) for up to 12 months when the following
				conditions are met:
A. The
			 need for absence must be for the purposes of treatment in a licensed or
			 certified program or facility for the purposes of behavior stabilization,
			 physical or mental health treatment.
B. The loss of home or loss of the primary
			 non-paid caregiver.
C. The request
			 must be in writing with supporting evidence included.
D. The request must be prior approved by
			 DDS.
E. A minimum of one visit or
			 one contact each month is required.
NOTE: The DDS Specialist is responsible for conducting or
				assuring the conducting of the contacts or monitoring visits with applicable
				documentation filed in the case record.
F. All requests for abeyance are to be faxed
			 to the DDS Waiver Program Director for
Adult and Waiver Services. Monthly status reports are required
				to be submitted to the DDS Waiver Program Director as long as the person is in
				abeyance. Each request for continuance must be submitted in writing and
				supported by evidence of treatment status or progress. Requests for continuance
				must be made prior to the expiration of the abeyance period.
In order for beneficiaries to continue to be eligible for
				waiver services while they are in abeyance the following two requirements must
				be met:
A. It must be
			 demonstrated that a beneficiary needs at least one waiver service as documented
			 in their person centered service plan.
B. Beneficiaries must receive at least one
			 waiver service per month or monthly monitoring.
As stated in the Medical Services Manual, Section 1348, an
				individual living in a public institution is not eligible for Medicaid.
A. Public institutions include
			 county jails, state and federal penitentiaries, juvenile detention centers, and
			 other correctional or holding facilities.
B. Wilderness camps and boot camps are
			 considered a public institution if a governmental unit has any degree of
			 administrative control.
C. Inmate
			 status will continue until the indictment against the individual is dismissed
			 or until he or she is released from custody either as "not guilty" or for some
			 other reason (bail, parole, pardon, suspended sentence, home release program,
			 probation, etc.)
Thus, a person who is living in a public institution as defined
				above would be closed under Medicaid and also under the waiver program.
211.100
Selection
			 Process for Entrance to the Waiver
Selection for entrance into the waiver is as follows:
A. In order of waiver application eligibility
			 determination date for persons determined to have successfully applied for the
			 waiver, but who through administrative error, were or are inadvertently omitted
			 from the waiver wait list.
B. In
			 order of waiver application eligibility determination date of persons for whom
			 waiver services are necessary to permit discharge from an institution, i.e.,
			 ICF/MR residents, nursing facility residents, and Arkansas State Hospital
			 patients; or admission to Supported Living Arrangements (group homes and
			 apartments).
C. In order of date
			 the Department of Human Services (DHS) custodian chose waiver services for
			 eligible person in the custody of DHS Division of Children and Family Services
			 or DHS Adult Protective Services.
D. In order of waiver application eligibility
			 determination date for all other persons.
Selection for priority consideration is in the order identified
				above. When more than one category of priority is identified in a ranking, the
				order of release shall be by date of eligibility determination within each
				category. Releases occur only when there is a vacant waiver slot.
211.200
Risk
			 Assessment
A. DDS will not authorize or
			 continue waiver services under the following conditions:
1. The health and safety of the beneficiary,
			 the beneficiary's caregivers, workers or others are not assured;
2. The beneficiary or legally responsible
			 person has refused or refuses to participate in the plan of care development or
			 to permit implementation of the plan of care or any part thereof that is deemed
			 necessary to assure health and safety;
3. The beneficiary or legally responsible
			 person refuses to permit the on-site entry of: case manager to conduct required
			 visits, caregivers to provide scheduled care, DDS, DMS, DHS or CMS officials
			 acting in their role as oversight authority for compliance or audit
			 purposes;
4. The beneficiary
			 applying for, or receiving, waiver services requires 24 hour nursing care on a
			 continuous basis as prescribed by a physician;
5. The beneficiary participating in the
			 waiver program is incarcerated, adjudicated as guilty or is an inmate in a
			 state or local correctional facility;
6. The person is deemed ineligible based on
			 DDS Psychological Team assessment or reassessment for meeting ICF/MR level of
			 care;
7. The beneficiary is deemed
			 ineligible based on not meeting or not complying with requirements for
			 determining continued Medicaid income eligibility.
B. Safeguards concerning the use of
			 Restraints or Seclusion:
1. Personal
			 restraints (use of a staff member's body to prevent injury to the consumer or
			 another person) is allowed in cases of emergency. An emergency exists when:
a. The individual has not responded to
			 de-escalation techniques and continues to escalate behavior,
b. The individual is a danger to self or
			 others, or c. The safety of the individual and those nearby cannot be assured
			 through positive reinforcers.
An individual must be continuously under direct observation of
				staff members during any use of restraints.
If the use of personal restraints occurs more than three times
				per month, use should be discussed by the interdisciplinary team and addressed
				in the plan of care. When emergency procedures are implemented, plan of care
				revisions including but not limited to, psychological counseling, review of
				medications with possible medication change or a change in environmental
				stressors that are noted to precede escalation of behavior may be
				implemented.
1. Mechanical restraints
			 fall under the same requirements as the use of personal restraints in that they
			 may only be used in emergency circumstances that places the individual or
			 others around the individual at serious threat of violence or risk of injury if
			 no intervention occurs. If emergency procedures are used more than three times
			 in six months, the interdisciplinary team must meet to revise the plan of
			 care.
2. DDS standards require that
			 providers will not allow maltreatment or corporal punishment (the application
			 of painful stimuli to the body in an attempt to terminate behavior or as a
			 penalty for behavior) of individuals. Provider's policies and procedures must
			 state that corporal punishment is prohibited.
3. Providers must develop a written behavior
			 management policy to ensure the rights of individuals. The policy must include
			 a provision for alternative methods to avoid the use of restraints and
			 seclusions.
The behavior management plan must specify what behaviors will
				constitute the use of restraints or seclusion, the length of time to be used,
				who will authorize the use of restraints or seclusion and the methods for
				monitoring the individual.
Behavior management plans cannot include procedures that are
				punishing, physically painful, emotionally frightening, depriving or that puts
				the individual at a medical risk.
When the behavior plan is implemented, all use of restraint
				must be documented in the individual's case record, including the initiating
				behavior, length of time of restraint, name of authorizing personnel, names of
				all individuals involved and outcomes of the event.
1. The use of restraints or seclusion must be
			 reported to the DDS Quality Assurance section via an incident report form that
			 must be submitted no later than the end of the second business day following
			 the incident. The DDS Quality Assurance staff investigates each incident and
			 monitors use of restraints for possible overuse or inappropriate use of
			 restraints or seclusion. DDS Quality Assurance staff will notify entities
			 involved with the complaint or service concern the results of their review. If
			 there is credible evidence to support the complaint or concern, the provider
			 will be required to submit a plan of correction. Failure to complete corrective
			 action measures may result in the provider being placed on provisional status
			 or revocation of certification.
2.
			 Each person working within the provider agency must complete Introduction to
			 Behavior Management, Abuse and Neglect and any other training as deemed
			 necessary as a result of deficiencies or corrective
			 actions.
C. Safeguards Concerning the use of
			 Restrictive Intervention
1. DDS Standards
			 require the use of a behavior management plan for all individuals who's
			 behavior may warrant intervention. The behavior management plan must specify
			 what will constitute the use of restrictive interventions, the length of time
			 to be used, who will authorize the use of restrictive intervention and the
			 methods for monitoring the individual.
When the behavior plan is implemented, all use of restrictive
				interventions must be documented in the individual's case record and should
				include the initiating behavior, length of time of restraint, name of
				authorizing personnel, names of all individuals involved and outcomes of the
				event.
2. Restrictive
			 interventions include:
a. Absence from a
			 specific social activity, or
b.
			 Temporary loss of a personal possession
These interventions might be implemented to deal with
				aggressive or disruptive behaviors related to the activity or possession.
				Staff, families and the individual are trained by the provider to recognize and
				report unauthorized use of restrictive interventions.
Before absence from a specific social activity or temporary
				loss of personal possession is implemented, the individual is first counseled
				about the consequences of the behavior and the choices they can make.
1. All personnel who are involved in the use
			 of restrictive interventions must receive training in behavior management
			 techniques, as well as, training in abuse and neglect laws, rules and
			 regulations and policies. The personnel must be qualified to perform, develop,
			 implement and monitor or provide direction intervention as
			 applicable.
2. Use of restrictive
			 interventions requires submission of an incident report that must be submitted
			 no later than the end of the second business day following the incident. The
			 DDS Quality Assurance staff investigates each incident and monitors use of
			 restrictive interventions for possible overuse or inappropriate use. DDS
			 Quality Assurance staff will notify entities involved with the complaint or
			 service concern the results of their review. If there is credible evidence to
			 support the complaint or concern, the provider will be required to submit a
			 plan of correction. Failure to complete corrective action measures may result
			 in the provider being placed on provisional status or revocation of
			 certification.
212.000
Description of Services
DDS ACS services provide the support necessary for a
				beneficiary to live in the community. Without these services, the beneficiary
				would require institutionalization.
Services provided under this program are as follows:
A. Supportive Living
B. Respite Services
C. Supported Employment
D. Adaptive Equipment
E. Environmental Modifications
F. Specialized Medical Supplies
G. Supplemental Support Service
H. Case Management Services
I. Consultation Services
J. Crisis Intervention Services
K. Community Transition Services
213.000
Supportive
			 Living
Supportive living is an array of individually tailored services
				and activities provided to enable eligible beneficiaries to reside successfully
				in their own homes, with their family, or in an alternative living residence or
				setting. Alternative living residences include apartments, homes of primary
				caregivers, leased or rented homes, or provider group homes. Supportive living
				services may also be provided in clinic and integrated community settings. The
				services are designed to assist beneficiaries in acquiring, retaining and
				improving the self-help, socialization and adaptive skills necessary to reside
				successfully in the home and community based setting. Services are flexible to
				allow for unforeseen changes needed in schedules and times of service delivery.
				Services are approved as maximum days that can be adjusted within the annual
				plan year to meet changing needs. The total number of days cannot be increased
				or decreased without a revision. Waiver funding will not reimburse for
				overtime. The payments for these services exclude the costs of the person's
				room & board expenses including general maintenance, upkeep or improvement
				to the person's home or their family's home.
A. Residential Habilitation Supports
Care and supervision of activities that directly relate to
				treatment goals & objectives. The supports that may be provided to a
				beneficiary include the following:
1.
			 Decision making including the identification of and response to dangerously
			 threatening situations, making decisions and choices affecting the person's
			 life and initiating changes in living arrangement or life activities;
2. Money management consists of training,
			 assistance or both in handling personal finances, making purchases and meeting
			 personal financial obligations;
3.
			 Daily living skills including habilitative training in accomplishing routine
			 housekeeping tasks, meal preparation, dressing, personal hygiene,
			 administration of medications (to the extent permitted under state law) and
			 other areas of daily living including proper use of adaptive and assistive
			 devices, appliances, home safety, first aid and emergency procedures;
4. Socialization, including training,
			 assistance or both, in participation in general community activities, and
			 establishing relationships with peers. Activity training includes assisting the
			 person to continue to participate on an ongoing basis;
5. Community experiences include activities
			 intended to instruct the person in daily living and community living skills in
			 a clinic and integrated setting. Included are such activities as shopping,
			 church attendance, sports, participation in clubs, etc. Community experiences
			 include activities and supports to accomplish individual goals or learning
			 areas including recreation and specific training or leisure activities. Each
			 activity is then adapted according to the beneficiary's individual
			 needs.
6. Non-medical
			 transportation to or from community integration experiences is an integral part
			 of this service and is included in the daily rate computation. DDS will assure
			 duplicate billing between waiver services and other Medicaid state plan
			 services will not occur. The habilitation objectives to be served by such
			 training must be documented in the person's service plan. Whenever possible,
			 family, neighbors, friends or community agencies that can provide this service
			 without charge must be utilized.
Exclusions: Transportation to and from medical, dental and
				professional appointments inclusive of therapists. Non-medical transportation
				does not include transportation for other household members.
7. Mobility including training, assistance or
			 both aimed at enhancing movement within the person's living arrangement,
			 mastering the use of adaptive aids and equipment, accessing and using public
			 transportation, independent travel or movement within the community;
8. Communication including training in
			 vocabulary building, use of augmentative communication devices and receptive
			 and expressive language;
9.
			 Behavior shaping and management includes training, assistance or both in
			 appropriate expressions of emotions or desires, compliance, assertiveness,
			 acquisition of socially appropriate behaviors or reduction of inappropriate
			 behaviors;
10. Reinforcement of
			 therapeutic services which consist of conducting exercises or reinforcing
			 physical, occupational, speech and other therapeutic programs;
11. Performance of tasks to assist or
			 supervise the person in such activities as meal preparation, laundry, shopping
			 and light housekeeping that are incidental to (not to exceed 20% of the total
			 weekly hours worked) the care and supervision of the beneficiary but cannot be
			 performed separately from other waiver services.
a. Assistance is defined as hands-on care
			 both of a supportive and health related nature, supports that substitute for
			 the absence, loss, diminution, or impairment of a physical or cognitive
			 function; homemaker or chore services, fellowship and protection that includes
			 medical oversight permitted under state law.
b. Services are furnished to persons who
			 receive these services in conjunction with residing in an alternate living
			 setting.
c. The total number of
			 individuals (including persons served in the waiver) living in an alternate
			 living setting who are unrelated to the principle care provider cannot exceed
			 four except where congregate settings are used that were licensed by DDS prior
			 to 1995.
12. Health
			 maintenance activities may be provided by a designated care aide (supportive
			 living worker). All health maintenance activities (to include oral medication
			 administration or assistance, shallow suctioning, maintenance and use of
			 intra-feeding and breathing apparatus or devices), except injections and IV's,
			 can be done in the home by a designated care aide, such as a supportive living
			 worker. With the exception of injectable medication administration, tasks that
			 beneficiaries would otherwise do for themselves, or have a family member do,
			 can be performed by a paid designated care aide at their direction, as long as
			 the criteria specified in the Arkansas Nurse Practices Consumer Directed Care
			 Act has been met. Health maintenance activities are available in the Arkansas
			 Medicaid State Plan as self directed services. State plan services must be
			 exhausted before accessing waiver funding for health maintenance
			 activities.
B. Companion
			 and Activities Therapy
Companion and activities therapy services provide reinforcement
				of habilitative training. This reinforcement is accomplished by using animals
				as modalities to motivate persons to meet functional goals. Through the
				utilization of an animals presence, enhancement and incentives are provided to
				persons to practice and accomplish such functional goals as follows:
1. Language skills;
2. Increase range of motion;
3. Socialization by developing the
			 interpersonal relationships skills of interaction, cooperation and trust and
			 the development of self-respect, self-esteem, responsibility, confidence and
			 assertiveness;
NOTE: This service does not include the purchase of animals,
				veterinary or other care, food, shelter or ancillary equipment that may be
				needed by the animal that is providing reinforcement.
C. Direct Care Supervision
The direct care supervisor employed by the supported living
				provider is responsible for assuring the delivery of all supported living
				direct care services including the following activities:
1. The coordination of all direct service
			 workers who provide care through the direct service provider;
2. Serving as liaison between the
			 beneficiary, parents, legal representatives, case management entity and DDS
			 officials;
3. Coordinating
			 schedules for both waiver and generic service categories;
4. Providing direct planning input and
			 preparing all direct service provider segments of any initial plan of care and
			 annual continued stay review;
5.
			 Assuring the integrity of all direct care service Medicaid waiver
			 billing;
6. Arranging for staffing
			 of all alternative living settings;
7. Assuring transportation as identified in
			 person centered service plan specific to supportive living services;
8. Assuring advance collaboration with the
			 case management entity to obtain comprehensive behavior and assessment reports,
			 continued stay reviews, revisions as needs change and information and documents
			 required for ICF/MR level of care and waiver Medicaid eligibility
			 determination;
9. Reviewing the
			 person's records and environments in which services are provided by accessing
			 appropriate professional sources to determine whether the person is receiving
			 appropriate support in the management of medication. Minimum components are as
			 follows:
The direct care supervisor has an on-going responsibility for
				monitoring beneficiary medication regimens. While the provider may not staff a
				person on a 24/7 schedule, the provider is responsible around the clock to
				assure that the person centered service plan identifies and addresses all the
				needs with other supports as necessary to assure the health and welfare of the
				beneficiary.
a. Staff, at all times,
			 are aware of the medications being used by the beneficiary.
b. Staff are knowledgeable of potential side
			 effects of the medications being used by the person through the prescribing
			 physician, nurse and pharmacist at the time medications are ordered.
c. All medications consumed are prescribed or
			 approved by the beneficiary's physician or other health care
			 practitioner.
d. The beneficiary or
			 legally responsible person is informed by the prescribing physician about the
			 nature and effect of medication being consumed and consent to the consumption
			 of those medications prior to consumption.
e. Staff are implementing the service
			 provider's policies and procedures as to medication management, appropriate to
			 the beneficiary's needs as monitored by the direct care supervisor in
			 accordance with acceptable personnel policies and practices and by the case
			 manager at least monthly.
f. If
			 psychotropic medications are being used for behavior, the direct care
			 supervisor and case manager are responsible to assure appropriate positive
			 behavior programming is present and in use with programming reviews at least
			 monthly.
g. The consumption of
			 medications is monitored at least monthly by the direct care supervisor to
			 ensure that they are accurately consumed as prescribed.
h. Toxicology screenings are conducted on a
			 frequency determined by the prescribing physician with case manager
			 oversight.
i. Any administration of
			 medication or other nursing tasks or activities are performed in accordance
			 with the Nurse Practice and Consumer Directed Care Acts is monitored by the
			 direct care supervisor in accordance with acceptable personnel practices and by
			 the case manager at least monthly.
j. Medications are regularly reviewed to
			 monitor their effectiveness, to address the reason for which they were
			 prescribed and for possible side effects.
k. Medication errors are effectively detected
			 by the direct care supervisor by review of the medication log and with
			 appropriate response up to and inclusive of incident reporting and reporting to
			 the Nursing Board.
l. Frequency of
			 monitoring is based on the physician's prescription for administration of
			 medication.
m. The physician
			 approving the service level of support and the person centered service plan is
			 responsible for monitoring and determining contraindications when multiple
			 medications are prescribed. A minimum review is at the annual continued stay
			 review of the person centered service plan for approval and recertification.
Direct care staff are required to complete daily activity logs
				for activities that occur during the work timeframe with such activities linked
				to the person centered service plan objectives. The direct care supervisor is
				required to monitor the work of the direct care staff and to sign-off on
				timesheets maintained to document work performed. All monitoring activities,
				reviews and reports must be documented and available upon request from
				authorized DDS or DMS staff.
NOTE: Failure to satisfactorily document activities
				according to DMS requirements may result in non-payment of
				services.
Persons may access both supportive living and respite on the
				same date as long as the two services are distinct, do not overlap and the
				daily rate maximum is correctly prorated as to the portion of the day that each
				respective service was actually provided. DDS monitors this provision through
				retrospective annual look behind with providers responsible to maintain
				adequate time records and activity case notes or activity logs that support the
				service deliveries. Maximum daily rate is established in accordance with budget
				neutrality wherein both supportive living and respite independently and
				collectively cannot exceed the daily maximum.
Controls in place to assure payments are only made for services
				rendered include requirement by assigned staff to complete daily activity logs
				for activities that occurred during the work timeframe with such activities
				linked to the plan of care objectives; supervision of staff by the direct care
				supervisor with sign off on timesheets maintained weekly; audits and reviews
				conducted by DDS Quality Assurance annually and at random; DDS Waiver Services
				annual retrospective reviews, random attendance at planning meetings and visits
				to the home; DMS random audits; and oversight by the chosen and assigned case
				Team.
213.100
Supportive Living Arrangements
			 (Provider owned group homes or apartments)
Persons residing in supportive living arrangements are eligible
				for the same services and service level as any other waiver participant. Staff
				working in such arrangements must have hours of compensation prorated according
				to the number of individuals, waiver and non-waiver, residing in the supportive
				living arrangement. Additional one-on-one staffing may be provided when the
				need is justified. Supportive living arrangements include:
A. Existing group homes serving groups of no
			 more than 14 unrelated adults (age 18 and older) with developmental
			 disabilities in the residential setting.
B. Existing DDS licensed supportive living
			 apartments serving up to 4 unrelated adults (age 18 and older) with
			 developmental disabilities in each self-contained apartment unit up to the
			 total number of licensed units in the complex.
C. Adults served in their family home, in
			 their own home or in an integrated apartment complex or in an alternative
			 living setting with no more than 4 unrelated adults with developmental
			 disabilities in the home.
D.
			 Children served in their family home or in an alternative family with no more
			 than 4 unrelated children with developmental disabilities in the home.
Exception: Only those supportive living apartments and group
				homes licensed by the DDS prior to July 1, 1995, are approved to serve more
				than 4 adults. No expansions will be approved beyond the July 1, 1995, total
				capacity (waiver and non-waiver).
213.200
Supportive Living
			 Exclusions
Only hired caregivers may be reimbursed for supportive living
				services provided.
The payments for these services exclude the costs of room and
				board, including general maintenance, upkeep or improvement to the
				beneficiary's own home or that of his or her family.
Routine care and supervision for which payment will not be made
				are defined as those activities that are necessary to assure a person's well
				being but are not activities that directly relate to active treatment goals and
				objectives.
Waiver funding will not reimburse for overtime. It is the
				responsibility of the provider to assure compliance with State and Federal
				Department of Labor, Wage and Hour Laws.
213.300
Benefit Limits for Supportive
			 Living
The maximum daily rate for the supportive living array, which
				includes both supportive living and respite services, collectively or
				individually is based upon the level of support identified in the beneficiaries
				person centered service plan. This daily rate includes provider indirect costs
				for each component of service. DDS must prior authorize daily rates for all
				levels of support.
Pervasive - maximum daily rate is $391.95 with a maximum annual
				rate of $143,061.75.
Extensive - maximum daily rate is $176.00 with a maximum annual
				rate of $64,240.00.
Limited - maximum daily rate is $176.00 with a maximum annual
				rate of $38,544.00.
See Section 260.000 for billing information.
See Section 224.000 for payment guidelines of relatives or
				legal guardians.
214.000
Respite Services
Respite services are provided on a short-term basis to
				beneficiaries unable to care for themselves due to the absence of or need for
				relief of non-paid primary caregivers. Room and board may not be claimed when
				respite is provided in the beneficiary's home or a private place of residence.
				Room and board is not a covered service except when provided as part of respite
				furnished in a facility that is approved by the State as a respite care
				facility.
Receipt of respite services does not necessarily preclude a
				beneficiary from receiving other services on the same day. For example, a
				beneficiary may receive day services, such as, supported employment on the same
				day as respite services.
When respite is furnished for the relief of a foster care
				provider, foster care services may not be billed during the period that respite
				is furnished. Respite may not be furnished for the purpose of compensating
				relief or substitute staff for supportive living services. Respite services are
				not to supplant the responsibility of the parent or guardian.
Respite services may be provided through a combination of basic
				child care and support services required to meet the needs of a child. When
				respite is provided in a licensed day care facility, licensed day care home, or
				other lawful child care setting, waiver will only pay for the support staff
				required by the beneficiary's developmental disability. Parents and guardians
				will remain responsible for the cost of basic child care fees.
Respite services are separate and distinct from educational
				services provided at a school where attendance is mandated and the primary
				focus of the institution is the accomplishment of specified educational
				goals.
Respite may be provided in the following locations:
A. Beneficiary's home or private place of
			 residence;
B. The private residence
			 of a respite care provider;
C.
			 Foster home;
D. Medicaid certified
			 ICF/MR;
E. Group home;
F. Licensed respite facility;
G. Other community residential facility
			 approved by the state, not a private residence.
H. Licensed or accredited residential mental
			 health facility.
I. Licensed day
			 care facility, licensed day care home or other lawful child care setting.
			 Waiver will only pay for support staff required due to developmental
			 disability. Waiver will not pay for day care fees.
214.100
Benefit Limits for Respite
			 Services
The maximum daily rate for the supportive living array, which
				includes both supportive living and respite services, collectively or
				individually is based upon the level of support identified in the beneficiaries
				person centered service plan. This daily rate includes provider indirect costs
				for each component of service. DDS must prior authorize daily rates for all
				levels of support.
Pervasive - maximum daily rate is $391.95 with a maximum annual
				rate of $143,061.75.
Extensive - maximum daily rate is $176.00 with a maximum annual
				rate of $64,240.00.
Limited - maximum daily rate is $176.00 with a maximum annual
				rate of $38,544.00.
See section 260.000 for billing information.
215.000
Supported Employment
Supported employment services consist of intensive, ongoing
				supports that enable beneficiaries for whom competitive employment at or above
				the minimum wage is unlikely or who, because of their disabilities, need
				intensive ongoing support to perform in a competitive work setting.
Supported employment is paid employment that is conducted in a
				variety of settings, particularly work sites in which individuals without
				disabilities are employed. When supported employment services are provided at a
				work site where persons without disabilities are employed, payment is made only
				for the adaptations, supervision and training required by beneficiaries
				receiving waiver services as a result of their disabilities. Coverage does not
				included payment for the supervisor activities rendered as a normal part of the
				business setting. The employer is responsible for making reasonable
				accommodations in accordance with the Americans with Disabilities Act.
Supported employment is a collaborative service with Arkansas
				Rehabilitation Services (ARS). All waiver beneficiaries receiving supported
				employment must be prior certified by ARS to assure the beneficiary is
				qualified for supported employment and that ARS funding has been accessed
				first.
Integration requires that a beneficiary work in a place where
				no more than eight people with disabilities work together and where co-workers
				without disabilities are present in the work setting or in the immediate
				vicinity. Supported employment services may be furnished by a co-worker or
				other job site personnel provided that the services which are furnished are not
				part of the normal duties of the co-worker or other personnel and these
				individuals meet the qualifications to be a provider of the supported
				employment service.
Supported employment includes:
A. Assisting the participant in locating a
			 job or developing a job on behalf of the participant
B. Activities needed to sustain paid work by
			 waiver beneficiaries, including supervision and training;
C. Re-training for job retention or job
			 enhancement;
D. Job site
			 assessments. The job coach, after consultation with each person in supported
			 employment, can determine on a case-by-case basis how to best acquire current
			 information relevant to assessing job stability and the beneficiary's
			 needs.
E. Job maintenance visits
			 with the employer for purposes of obtaining, maintaining or retaining current
			 or new employment opportunities.
Transportation between the beneficiary's place of residence and
				the site of employment, is included as a component part of supported employment
				services. The cost of this transportation is included in the rate paid to
				providers.
Personal assistance may be a component part of supported
				employment but may not need to comprise the entirety of the service.
Supported employment may include services and supports that
				assist the beneficiary in achieving self-employment through the operation of a
				business. However, Medicaid funds may not be used to defray the expenses
				associated with starting up or operating a business. Assistance for
				self-employment may include:
A. Aiding the beneficiary to identify
			 potential business opportunities;
B. Assistance in the development of a
			 business plan, including potential sources of business financing and other
			 assistance in developing and launching a business;
C. Identification of the supports that are
			 necessary for the beneficiary to operate the business; and
D. Ongoing assistance, counseling and
			 guidance once the business is launched.
Beneficiaries receiving supported employment services may also
				receive educational, prevocational and day habilitation services. A
				beneficiary's service plan may include two or more types of non-residential
				habilitation services. However, different types of non-residential habilitation
				services may not be billed during the same period of the day.
215.100
Supported
			 Employment Exclusions
Supported employment requires related activities to be
				identified and included in outcomes with an accompanying work plan submitted as
				documentation of need for service.
Payment for employment services excludes:
A. Incentive payments made to an employer of
			 waiver beneficiaries to encourage or subsidize an employer's participation in
			 the program.
B. Payments that are
			 passed through to waiver beneficiaries.
C. Payments for training that are not
			 directly related to the waiver beneficiary's employment.
D. Reimbursement if the beneficiary is not
			 able to perform the essential functions of the job. The functions of a job
			 coach are to "coach," not to do the work for the person.
E. ACS waiver supported employment services
			 when the same services are otherwise funded under the Rehabilitation Act of
			 1973 or Public Law 94-142. This means that such services must be exhausted
			 before waiver-supported employment services can be approved or reimbursement
			 can be claimed.
F. Services
			 provided in a sheltered workshop or other similar type of vocational service
			 furnished in a specialized facility.
215.200
Documentation Requirements for
			 Supported Employment
Supported employment providers must maintain documentation in
				each waiver beneficiary's file to demonstrate the service is not available
				under a program funded under Section 110 of the Rehabilitation Act of 1973 or
				Individual with Disabilities Education Act (
				20
				U.S.C. 1401 et.seq).
Documentation must include proof from the funded provider where
				services were exhausted.
See Section 202.200 for other information to be retained for
				beneficiary's file.
215.300
Benefit Limits for Supported Employment
Beneficiaries are limited to a maximum of $3.59 per 15 minute
				unit with a maximum of 32 units (8 hours) of supported employment services per
				date of service.
Supported employment, provided as long term support, requires
				monitoring at a minimum of two meetings with the beneficiary and one employer
				contact each month. The person is required to work a minimum of 15 hours per
				week in accordance with ARS regulation. Exceptions must be justified by the
				beneficiary's case manager and must be prior approved by ARS. ARS must approve
				any exception with monthly monitoring. The beneficiary's case manager must
				prepare in writing a justification citing why the person cannot work at least
				15 hours per week and submit to the ARS counselor assigned to the case.
See section
				260.000 for billing
				information.
216.000
Adaptive Equipment
The adaptive equipment service includes an item or a piece of
				equipment that is used to increase, maintain or improve functional capabilities
				of individuals to perform daily life tasks that would not be possible
				otherwise. The adaptive equipment service provides for the purchase, leasing,
				and as necessary, repair of adaptive, therapeutic and augmentative equipment
				that enables individuals to increase, maintain or improve their functional
				capacity to perform daily life tasks that would not be possible
				otherwise.
Adaptive equipment needs for supportive employment are
				included. This service may include specialized equipment such as devices,
				controls or appliances that will enable the person to perceive, to control or
				to communicate with the environment in which they live.
Equipment may only be covered if not available to the
				beneficiary from any other source. Professional consultation must be accessed
				to ensure that the equipment will meet the needs of the beneficiary when the
				purchase will at a minimum, but not necessarily, exceed $500.00. Consultation
				must be conducted by a medical professional as determined by the beneficiary's
				condition for which the equipment is needed. All items must meet applicable
				standards of manufacture, design and installation.
All adaptive equipment must be solely for the waiver
				beneficiary. All purchases must meet the conditions for desired quality at the
				least expensive cost. Generally, any modifications over $1,000.00 will require
				three bids with the lowest bid with comparable quality being awarded; however,
				DDS may require three bids for any requested purchase.
Computer equipment may be approved when it allows the
				beneficiary control of his or her environment, assists in gaining independence
				or when it can be demonstrated that it is necessary to protect the health and
				safety of the person. Computers will not be purchased to improve socialization
				or educational skills. Printers may be approved for non-verbal persons.
Communication boards are allowable devices. Computers may be
				approved for communication when there is substantial documentation that a
				computer will meet the needs of the person more appropriately than a
				communication board.
Software will be approved only when required to operate the
				accessories included for environmental control or to provide text-to-speech
				capability.
NOTE: Adaptive equipment must be an item that is modified
				to fit the needs of the beneficiary. Items such as toys, gym equipment, sports
				equipment, etc. are excluded as not meeting the service
				definition.
Conditions:
The care and maintenance of, adaptive
				equipment, vehicle modifications, and personal emergency response systems are
				entrusted to the beneficiary or legally responsible person for whom the aids
				are purchased. Negligence (defined as failure to properly care for or perform
				routine maintenance of) shall mean that the service will be denied for a
				minimum of two plan years. Any abuse or unauthorized selling of aids by the
				beneficiary or legally responsible person shall mean the aids will not be
				replaced using waiver funding.
Exclusions:
A. Swimming pools (in-ground or above ground)
			 and hot tubs are not allowable as either an environmental modification or
			 adaptive equipment.
B. Therapeutic
			 tools similar to those therapists employ during the course of therapy are not
			 included.
C. Educational aids are
			 not included.
D. Computers will not
			 be purchased to improve socialization or educational skills.
E. Computer supplies.
F. Computer desk or other furniture items are
			 not covered.
G. Medicaid purchased
			 equipment cannot be donated if the equipment being donated is needed by another
			 waiver beneficiary residing in the residence.
216.100
Vehicle Modifications
Vehicle modifications are adaptations to an automobile or van
				to accommodate the special needs of the beneficiary. Vehicle adaptations are
				specified by the service plan as necessary to enable the beneficiary to
				integrate more fully into the community and to ensure the health, welfare, and
				safety of the beneficiary.
Payment for permanent modification of a vehicle is based on the
				cost of parts and labor, which must be quoted and paid separately from the
				purchase price of the vehicle to which the modifications are or will be
				made.
Transfer of any part of the purchase price of a vehicle,
				including preparation and delivery, to the price of a modification is a
				fraudulent activity. All suspected fraudulent activity will be reported to the
				Program Integrity Section of the Division of Medical Services for
				investigation.
Reimbursement for a permanent modification cannot be used or
				considered as down payment for a vehicle.
Lifts that require vehicle modification and the modifications
				are, for purposes of approval and reimbursement, one project and cannot be
				separated by plan of care years in order to obtain up to the maximum for each
				component.
Permanent vehicle modifications may be replaced if the vehicle
				is stolen, damaged beyond repair as long as the damage is not through
				negligence of the vehicle owner, or used for more than its reasonable useful
				lifetime.
A. A vehicle has reached its
			 reasonable useful lifetime when repairs are required to make the vehicle
			 useable, and the cost of the repairs exceeds the fair market value of the
			 vehicle in repaired condition.
B.
			 Cost of repair shall be determined by repair estimates from three qualified
			 repairers.
C. Vehicle value shall
			 be determined by reference to sales listing for similar vehicles within a 200
			 mile radius of the beneficiary's home, and to listings in Dallas, Texas; Kansas
			 City, Missouri; Saint Louis, Missouri and Memphis, Tennessee.
D. If the beneficiary or legally responsible
			 party sells or trades a permanently modified vehicle before the vehicle reaches
			 its reasonable useful lifetime, the modification will not be replaced on any
			 replacement vehicle. Instead, the beneficiary may be eligible for partial
			 payment based on the estimated remaining residual value of the vehicle at the
			 time of sale.
1. Estimated residual value
			 shall be determined by comparing the purchase price of the modified vehicle
			 when acquired by the beneficiary or legally responsible party when the vehicle
			 value at the time of sale determined as stated above.
2. Example: A permanently modified vehicle
			 purchased for $30,000 is sold with a value of $20,000 (66% residual value). If
			 parts and labor for the modification of the replacement vehicle are $10,000,
			 the amount paid is $3,333 (33%).
E. Vehicle modifications apply only to
			 modifications and not to routine auto maintenance or repairs for the
			 vehicle.
F. The following are
			 specifically excluded:
1. Adaptations or
			 improvements to the vehicle that are of general utility and are not of direct
			 medical or remedial benefit to the beneficiary;
2. Purchase, down payment or lease of a
			 vehicle as documented by the vehicle sales contract and requested
			 invoices;
3. Regularly scheduled
			 upkeep and maintenance of a vehicle, except upkeep and maintenance of the
			 modification.
216.200
Personal Emergency Response
			 System (PERS)
PERS may be approved when it can be demonstrated as necessary
				to protect the health and safety of the beneficiary. PERS is an electronic
				device that enables beneficiaries at high risk of institutionalization to
				secure help in an emergency. The beneficiary may also wear a portable "help"
				button to allow for mobility. The system is connected to the beneficiary's
				telephone and programmed to signal a response center once the "help" button is
				activated. The response center must be staffed by trained professionals. PERS
				services are limited to beneficiaries who live alone or who are alone for
				significant parts of the day and have no regular caregiver for extended periods
				of time and who would otherwise require routine supervision. Included in this
				service are assessment, purchase, installation, testing, and monthly rental
				fees.
216.300
Benefit
			 Limits for Adaptive Equipment
The maximum annual expenditure for adaptive equipment is
				$7,687.50 per person per year. If the person is also receiving environmental
				modification services, the COMBINED annual expenditure cannot exceed
				$7,687.50.
217.000
Environmental Modifications
Environmental modifications are made to or at the waiver
				beneficiary's home, required by the person centered service plan and are
				necessary to ensure the health, welfare and safety of the beneficiary or that
				enable the beneficiary to function with greater independence and without which
				the beneficiary would require institutionalization.
Environmental modification may include the installation of
				ramps and grab-bars, widening of doorways, modification of bathroom facilities
				, installation of specialized electric and plumbing systems to accommodate
				medical equipment, installation of sidewalks or pads to accommodate ambulatory
				impairments, and home property fencing when medically necessary to assure
				non-elopement, wandering or straying of persons who have dementia, Alzheimer's
				disease or other causes of memory loss or confusion as to location or decreased
				mental capacity or aberrant behaviors.
Expenses for the installation of the environmental modification
				and any repairs made necessary by the installation process are allowable.
				Portable or detachable modifications that can be relocated with the beneficiary
				and that have a written consent from the property owner or legal representative
				will be considered. Requests for modification must include an original photo of
				the site where modifications will be done; to scale sketch plans of the
				proposed modification project; identification of other specifications relative
				to materials, time for project completion ad expected outcomes; labor and
				materials breakdown and assurance of compliance with any local building codes.
				Final inspection for the quality of the modification and compliance with
				specifications and local codes is the responsibility of the waiver case
				manager. Payment to the contractor is to be withheld until the work meets
				specifications including a signed customer satisfaction statement.
All services must be provided as directed by the beneficiary's
				person centered service plan and in accordance with all applicable state or
				local building codes.
Environmental modifications must be made within the existing
				square footage of the residence and cannot add to the square footage of the
				building.
Modifications are considered and approved as single,
				all-encompassing projects and, as such, cannot be split whereby a part of the
				project is submitted in one service plan year and another part submitted in the
				next service plan year. Any such activity is prohibited. All modifications must
				be completed within the plan of care year in which the modifications are
				approved.
All purchases must meet the conditions for desired quality at
				the least expensive cost. Generally, any modifications over $1,000.00 will
				require three bids with the lowest bid with comparable quality being awarded,
				however, DDS may require three bids for any requested modification.
217.100
Environmental
			 Modifications Exclusions
Modifications or improvements made to or at the beneficiary's
				home which are of general repair and are not of direct medical or remedial
				benefit to the beneficiary (e.g., carpeting, roof repair, central air
				conditioning, etc.) are excluded as covered services. Also excluded are
				modifications or improvements that are of aesthetic value such as designer
				wallpaper, marble counter tops, ceramic tile, etc. Outside fencing is limited
				to one fence per lifetime. Total perimeter fencing is excluded. Expenses for
				remodeling or landscaping which are cosmetic, designed to hide the existence of
				the modification, or result from erosion are not allowable. Environmental
				modifications that are permanent fixtures will not be approved for rental
				property without prior written authorization and a release of current or future
				liability by the residential property owner.
Environmental modifications may not be used to adapt living
				arrangements that are owned or leased by providers of waiver services.
Swimming pools (both in and out of ground) and hot tubs (spas)
				are not allowable.
The moving of modifications, such as fencing or ceiling tracks
				and adaptive equipment that may be permanently affixed to the structure or
				outside premises is not allowable.
Conditions:
The care and maintenance of
				environmental modifications is entrusted to the beneficiary or legally
				responsible person for whom the modifications are purchased. Negligence
				(defined as failure to properly care for or perform routine maintenance of)
				shall mean that the service will be denied for a minimum of two plan years. Any
				abuse or unauthorized selling of aids by the beneficiary or legally responsible
				person shall mean the aides will not be replaced using waiver
				funding.
217.200
Benefit Limits for Environmental Modifications
A beneficiary's annual expenditure for environmental
				modifications cannot exceed $7,687.50 per person per year. If the beneficiary
				is also receiving adaptive equipment services, the COMBINED total cannot exceed
				$7,687.50.
218.000
Specialized Medical Supplies
Specialized medical equipment and supplies include:
A. Items necessary for life support or to
			 address physical conditions along with the ancillary supplies and equipment
			 necessary for the proper functioning of such items.
B. Durable and non-durable medical equipment
			 not available under the Arkansas Medicaid State Plan that is necessary to
			 address beneficiary functional limitations.
C. Necessary medical supplies not available
			 under the Arkansas Medicaid State Plan. Items reimbursed with waiver funds are
			 in addition to any medical equipment and supplies furnished under the state
			 plan and exclude those items that are not of direct medical or remedial benefit
			 to the beneficiary. All items shall meet applicable standards of manufacture,
			 design and installation.
D. A
			 physician must order or document the need for all specialized medical supplies.
Additional supply items are covered as a waiver service when
				they are considered essential for home and community-care. Covered items
				include:
A. Nutritional
			 supplements
B. Non-Prescription
			 medications. Alternative medicines not Federal Drug Administration approved are
			 excluded from coverage.
C.
			 Prescription drugs, minus the cost of drugs covered by Medicare Part D, when
			 extended benefits available under the Arkansas Medicaid State Plan.
Item(s) must be included in the person centered service plan.
				When the items are included in Arkansas Medicaid State Plan services, a denial
				of extension of benefits by DMS Utilization Review will be required prior to
				approval for waiver funding by DDS.
218.100
Benefit Limits for Specialized
			 Medical Supplies
The maximum annual allowance for specialized medical supplies,
				supplemental supports and community transition services is $3690.00,
				collectively or individually.
When a non-prescription or prescription medication is necessary
				to maintain or avoid health deterioration, the $3,690.00 limit may be increased
				with the difference in the specialized medical supplies maximum allowance and
				the required amount deducted from the supportive living maximum daily
				allowance. All such requests must be prior approved by the DDS Assistant
				Director of Waiver Services.
See Section 260.000 for billing information.
219.000
Supplemental Support
			 Service
The supplemental support service helps improve or enable the
				continuance of community living. This service is only available in response to
				crisis, emergency or life threatening situations. Supplemental support service
				will be based on demonstrated needs as identified in a beneficiary's person
				centered service plan as emergencies arise. Waiver funds will be used as the
				payer of last resort.
Supplemental support service includes:
A. Ancillary supports such as non-recurring
			 set-up expenses for beneficiaries in the event of a disaster, crisis, emergency
			 or life threatening situation. Allowable expenses are those necessary to enable
			 a person to establish a basic household that do not constitute room and board
			 and may include:
1. Security deposits that are
			 required to obtain a lease on an apartment or home;
2. Essential household furnishings and moving
			 expense required to occupy and use a community domicile, including furniture,
			 window coverings, food preparation items, and bed/bath linens;
3. Set-up fees or deposits for utility or
			 service access, including telephone, electricity, heating and water;
4. Services necessary for the beneficiary's
			 health and safety such as pest eradication and one-time cleaning prior to
			 occupancy;
5. Moving expenses.
These services are furnished only to the extent that it is
				reasonable and necessary as determined through the service plan development
				process, clearly identified in the service plan and the person is unable to
				meet such expense or when the services cannot be obtained from other
				sources.
B. Drug
			 and alcohol screening in accordance with the beneficiary's treatment plan. A
			 physician, psychologist or court of law must order drug and alcohol
			 screening
C. Activity fees such as
			 dues at YMCA, Weight Watchers, etc. used for behavior reinforcement (may
			 include weight control or health related conditions) or sensory simulation.
			 Fees may be paid only for the waiver beneficiary and for such time as to abate
			 the life threatening condition. These services must be prescribed and monitored
			 by medical professionals.
219.100
Supplemental Support Service
			 Exclusions
The supplemental support service is not allowed for monthly
				rental, lease or mortgage expenses, regular utility charges, household
				appliances, items that are intended for purely diversional or recreational in
				nature (televisions, cable TV access, VCRs or DVD players), therapy or
				educational aids.
Supplemental support may not be used to pay for furnishing
				living arrangements that are owned or leased by a waiver provider where the
				provision of these items and services are inherent to the service the provider
				is already delivering. Supplemental support may not be used for these or any
				other room-and board service.
219.200
Supplemental Support Service
			 Benefit Limits
This service can be accessed only as a last resort. Lack of
				other available resources must be proven.
The maximum annual allowance for supplemental support,
				community transition services, and specialized medical supplies is $3,690.00,
				collectively or individually.
220.000
Case Management Services
Case management services assist beneficiaries in gaining access
				to needed waiver services and other Arkansas Medicaid State Plan services, as
				well as medical, social, educational and other generic services, regardless of
				the funding source to which access is available.
Case management services include responsibility for guidance
				and support in all life activities. The intent of case management services is
				to enable waiver beneficiaries to receive a full range of appropriate services
				in a planned, coordinated, efficient and effective manner.
These activities include locating, coordinating, assuring the
				implementation of and monitoring:
A.
			 All proposed waiver services
B.
			 Other Medicaid state plan services
C. Needed medical, social, educational and
			 other publically funded services, regardless of the funding source
D. Informal community supports
Case management services consist of the following
				activities:
A. Arranging for
			 the provision of services and additional supports
B. Monitoring and reviewing beneficiary
			 services included in the person centered service plan
C. Facilitating crisis intervention
D. Guidance and support to obtain generic
			 services and supports
E. Case
			 planning
F. Needs assessment and
			 referral for resources
G.
			 Monitoring to assure quality of care
H. Case reviews that focus on the
			 beneficiary's progress in meeting goals and objectives established through the
			 case plan
I. Providing assistance
			 relative to obtaining Waiver Medicaid eligibility and ICF/MR level of care
			 eligibility determinations
J.
			 Assuring the integrity of all case management Medicaid Waiver billing in that
			 the service delivered must have prior authorization and meet required waiver
			 service definitions and must be delivered before billing can occur
K. Assuring submission of timely (advance)
			 and comprehensive behavior and/or assessment reports, continued plans of care,
			 revisions as needs change, and information and documentation required for
			 ICF/MR level of care and waiver Medicaid eligibility determinations
L. Arranging for access to advocacy services
			 as requested by the beneficiary in the event that case management and direct
			 service are the same provider entity. The case manager and the direct care
			 supervisor can never be the same person for a waiver participant.. The direct
			 care supervisor is the person responsible for the interviewing, hiring, firing,
			 training, and scheduling of direct care staff providing supportive living
			 services. This is separate and apart from the case manager
			 responsibilities.
M. Monitoring and
			 reviewing services to assure health and safety of the beneficiary.
N. Upon receipt of DDS approvals or denials
			 of requested services, the case manager ensures that a copy is provided to the
			 beneficiary or legal representative.
O. Provides assistance with the appeals
			 process when the appeal option is chosen by the beneficiary or legal
			 representative.
P. Planning
			 meetings are scheduled by the case manager on behalf of the waiver participant,
			 at a time and in a location that is convenient for the waiver participant or
			 legal representative. The planning meeting will only include the case , the
			 waiver participant or legal representative and other persons invited by the
			 waiver participant.
Case Management will be provided up to a maximum of a 90 day
				transition period for all persons who seek to voluntarily withdraw from waiver
				services unless the individual does not want to continue to receive the
				service. The transition period will allow for follow up to assure that the
				person is referred to other available services and to assure that the person's
				needs can be met through optional services. It also serves to assure that the
				person understands the effects and outcomes of withdrawal and to ascertain if
				the person was coerced or otherwise was unduly influenced to withdraw. During
				this 90 day timeframe, the person remains enrolled in the waiver, the case
				remains open, and waiver services will continue to be available until the
				beneficiary finalizes their intent to withdraw.
Case Management services may not include activities or services
				that constitute the provision of direct services to the beneficiary that are
				normally covered as distinct services (e.g. the transportation of beneficiaries
				to sites where waiver services are furnished or they receive state plan
				services).
Service gaps of thirty (30) consecutive days must be reported
				to the DDS Specialist assigned to the case with a copy of the report sent to
				the DDS Program Director. The report must include the reason for the gap and
				identify remedial action to be taken.
Case management services are available at three levels of
				support. They are:
A.
			 Pervasive - Minimum of one face-to-face visit AND one other contact with the
			 beneficiary or legal representative monthly. At least one visit must be made
			 annually at the beneficiary's place of residence.
B. Extensive - Minimum of one face-to-face
			 visit with the beneficiary or legal representative each month. At least one
			 visit must be made annually at the beneficiary's place of residence.
C. Limited - Minimum of one face-to-face
			 visit with the beneficiary or legal representative each quarter and a minimum
			 of one contact monthly for the months when a face-to-face visit is not made. At
			 least one visit must be made annually at the beneficiary's place of residence.
The level of support is determined by the needs or options of
				the person receiving waiver services as defined in sections 230.211, 230.212
				and 230.213.
See section 260.000 for billing information.
220.100
Transitional Case Management
Case Management services may be available during the last 180
				consecutive days of a Medicaid eligible person's institutional stay to allow
				case management activities to be performed related to transitioning the person
				to the community. The person must be approved and in the waiver program for
				case management to be billed. All transition services must be reasonable and
				necessary, not available to the participant through other means, and clearly
				specified in the waiver participant's service plan. Once the beneficiary has
				been approved to transition to the waiver, a prior authorization for this
				service will be issued.
If the individual does not enroll in the waiver due to death or
				significant change in condition, transition activities may be reimbursed,
				depending on all eligibility factors.
220.200
Benefit Limits for Case
			 Management
There is a maximum reimbursement limit of $117.70 per month and
				$1,412.40 annually per person per year.
221.000
Consultation Services
Consultation services are clinical and therapeutic services
				which assist waiver beneficiaries, parents, guardians, legally responsible
				individuals, and service providers in carrying out the beneficiary's person
				centered service plan.
A. Consultation
			 activities may be provided by professionals who are licensed as:
1. Psychologists
2. Psychological examiners
3. Mastered social workers
4. Professional counselors
5. Speech pathologists
6. Occupational therapists
7. Physical therapists
8. Registered nurses
9. Certified parent educators or provider
			 trainer
10. Certified communication
			 and environmental control specialists
11. Dieticians
12. Rehabilitation counselors
13. Recreational therapists
14. Qualified Mental Retardation Professional
			 (QMRP)
15. Positive Behavioral
			 Supports (PBS) Specialist
These services are indirect in nature. The parent educator or
				provider trainer is authorized to provide the activities identified below in
				items 2, 3, 4, 5, 7, and 13. The provider agency will be responsible for
				maintaining the necessary information to document staff qualifications. Staff
				who meet the certification criteria necessary for other consultation functions
				may also provide these activities. Selected staff or contract individuals may
				not provide training in other categories unless they possess the specific
				qualifications required to perform the other consultation activities. Use of
				this service for provider training cannot be used to supplant provider trainer
				responsibilities included in provider indirect costs.:
B. Activities involved in
			 consultation services include:
1. Provision
			 of updated psychological and adaptive behavior assessments
2. Screening, assessing and developing
			 therapeutic treatment plans
3.
			 Assisting in the design and integration of individual objectives as part of the
			 overall individualized service planning process as applicable to the
			 consultation specialty
4. Training
			 of direct services staff or family members in carrying out special community
			 living services strategies identified in the person centered service plan as
			 applicable to the consultation specialty
5. Providing information and assistance to
			 the individuals responsible for developing the beneficiary's person centered
			 service plan as applicable to the consultation specialty
6. Participating on the interdisciplinary
			 team, when appropriate to the consultant's specialty
7. Consulting with and providing information
			 and technical assistance with other service providers or with direct service
			 staff and/or family members in carrying out a beneficiary's person centered
			 service plan specific to the consultant's specialty
8. Assisting direct services staff or family
			 members in making necessary program adjustments in accordance with the person's
			 person centered service plan as applicable to the consultation
			 specialty
9. Determining the
			 appropriateness and selection of adaptive equipment to include communication
			 devices, computers and software consistent with the consultant's
			 specialty
10 Training and/or
			 assisting persons, direct services staff or family members in the set up and
			 use of communication devices, computers and software consistent with the
			 consultant's specialty
11.
			 Screening, assessing and developing positive behavior support plans; assisting
			 staff in implementation, monitoring, reassessment and modification of the
			 positive behavior support plan consistent with the consultant's
			 specialty
12. Training of direct
			 services staff and/or family members by a professional consultant in:
a. Activities to maintain specific behavioral
			 management programs applicable to the person
b. Activities to maintain speech pathology,
			 occupational therapy or physical therapy program treatment modalities specific
			 to the person
c. The provision of
			 medical procedures not previously prescribed but now necessary to sustain the
			 person in the community
13. Training or assisting by advocacy to
			 beneficiaries and family members on how to self-advocate
14. Rehabilitation counseling for the
			 purposes of supported employment supports that do not supplant the Federal
			 Rehabilitation Act of 1973 and PL 94-142 and the supports provided through
			 Arkansas Rehabilitation Services
15. Training and assisting persons, direct
			 services staff or family members in proper nutrition and special dietary
			 needs.
221.100
Benefit Limits for Consultation
			 Services
The maximum amount payable per year for consultation services,
				per person is $1,320.00 or $136.40 per hour See section 260.000 for billing
				information.
222.000
Crisis Intervention Services
Crisis intervention services are defined as services delivered
				in the beneficiary's place of residence or other local community site by a
				mobile intervention team or professional.
Intervention services must be available 24 hours a day, 365
				days a year and must be targeted to provide technical assistance and training
				in the areas of behavior already identified. Services are limited to a
				geographic area conducive to rapid intervention as defined by the provider
				responsible to deploy the team or professional. Services may be provided in a
				setting as determined by the nature of the crisis, i.e., residence where
				behavior is happening, neutral ground, local clinic or school setting, etc. The
				following criteria must be met:
A. The
			 beneficiary is receiving waiver services
B. The beneficiary needs non-physical
			 intervention to maintain or re-establish behavior management or positive
			 programming plan
C. Intervention is
			 on-site in the community
A beneficiary may require one hour or a maximum of twenty-four
				hours of service during any one day. The maximum rate of reimbursement for this
				service is $127.10 per hour.
See Section 260.000 for billing information.
223.000
Community Transition
			 Services
Community transition services are non-recurring set-up expenses
				for beneficiaries who are transitioning from an institutional or another
				provider-operated living arrangement to a living arrangement in a private
				residence where the person is directly responsible for his or her own living
				expenses. Waiver funds can be accessed once it has been determined that the
				waiver is the payer of last resort.
Allowable expenses are those necessary to enable a person to
				establish a basic household that do not constitute room and board and may
				include:
A. Security deposits that are
			 required to obtain a lease on an apartment or home;
B. Essential household furnishings and moving
			 expense required to occupy and use a community domicile, including furniture,
			 window coverings, food preparation items, and bed/bath linens;
C. Set-up fees or deposits for utility or
			 service access, including telephone, electricity, heating and water;
D. Services necessary for the beneficiary's
			 health and safety such as pest eradication and one-time cleaning prior to
			 occupancy;
E. Moving expenses;
			 and
F. Necessary home accessibility
			 adaptations.
Community transition services are furnished only to the extent
				that they are reasonable and necessary as determined through the service plan
				development process, clearly identified in the person centered service plan and
				the person is unable to meet such expense or when the services cannot be
				obtained from other sources.
Duplication of environmental modifications will be prevented
				through DDS control of prior authorizations for approvals.
Costs for community transition services furnished to
				beneficiaries returning to the community from a Medicaid institutional setting
				through entrance to the waiver, are considered to be incurred and billable when
				the person leaves the institutional setting and enters the waiver. The
				beneficiary must be reasonably expected to be eligible for and to enroll in the
				waiver. If for any unseen reason, the beneficiary does not enroll in the waiver
				(e.g., due to death or a significant change in condition), transitional
				services may be billed to Medicaid as an administrative cost.
Exclusions
: Community transition services may not
				include payment for room and board; monthly rental or mortgage expense; food,
				regular utility charges; and/or household appliances or items that are intended
				for purely diversional or recreational purposes. Community transition services
				may not be used to pay for furnishing living arrangements that are owned or
				leased by a waiver provider where the provision of these items and services are
				inherent to the service they are already providing.
Diversionary or recreational items such as televisions, cable
				TV access, VCR's or DVD players are not allowable.
All transition services must be reasonable and necessary, not
				available to the participant through other means, and clearly specified in the
				waiver participant's service plan. Once the beneficiary has been approved to
				transition to the waiver, a prior authorization for this service will be
				issued.
If the individual does not enroll in the waiver due to death or
				significant change in condition, transition activities may be reimbursed,
				depending on all eligibility factors.
223.100
Benefit Limits for Community
			 Transition Services
The maximum annual allowance for supplemental support,
				community transition services, and specialized medical supplies is $3,690.00,
				collectively or individually.
See section 260.000 for billing information.
224.000
Payment to Relatives or Legal
			 Guardians
Payment for waiver services will not be made to the adoptive or
				natural parent, stepparent or legal representative or legal guardian of a
				person less than 18 years old. Payments will not be made to a spouse or a legal
				representative for a person 18 years of age or older. The employment of
				eligible relatives (regardless of the waiver beneficiary's age) shall require
				prior approval from DDS authority.
Payment to relatives, other than parents of minor children,
				legal guardians, custodians of minors or adults, or the spouse of adults, must
				be prior approved by DDS to provide services. For purposes of exclusion,
				"parent" means natural or adoptive parents and step parents. For any service
				provider, all DDS qualifications and standards must be met before the person
				can be approved as a paid service provider. Qualified relatives, other than as
				specified in the foregoing, can provide any service.
Employees will only be reimbursed for 40 hours per week, thus
				helping to assure the absence of undue influence in the person centered service
				plan.
In no case will a parent or legal guardian be reimbursed for
				the provision of transportation for a minor.
Controls for services rendered: All care staff are required to
				document all services provided daily according to their work schedules, direct
				care support service supervisors are responsible for the day to day supervision
				and monitoring of the direct care staff; case managers are responsible to
				periodically review with the beneficiary any problems in care delivery and
				report any deficiencies to the Waiver DD Specialist and DDS Quality Assurance
				provider certification staff. DDS specialists conduct a 100% review of service
				utilization for each plan of care at the time of each plan of care 12 month
				expiration date to identify any gaps in approved services with corrective
				action by the provider to be taken; DDS Quality Assurance conducts annual
				provider reviews; and DMS conducts both random Quality Assurance audits and
				audits specific to the financial integrity of services delivered.
230.000
Categorical
			 Eligibility Determination
Current eligibility for the Arkansas Medicaid Program must be
				verified as part of the intake and assessment process for admission into the
				ACS Waiver Program. Medicaid eligibility is determined by the Division of
				Developmental Disabilities Services or by the Social Security Administration
				for SSI Medicaid eligible's.
Failure to obtain any required eligibility determination,
				whether initial or subsequent (time bound) reassessments, will result in the
				beneficiary's case being closed. Once closure has occurred, and the appeals
				processes are exhausted, the affected person will have to make a new request
				for services through the waiver program intake process.
For the supportive living arrangements, the Medicaid
				eligibility date is retroactive to the date the Medicaid application is
				received at the DDS Medicaid Unit or no more than three months prior to the
				receipt of the Medicaid application, whichever is less.
230.100
Level of Care
			 Determination
Based on intellectual and behavioral assessment submitted by
				the provider, the ICF/MR level of care determination is performed by the
				Division of Developmental Disabilities. The ICF/MR level of care criteria
				provides an objective and consistent method for evaluating the need for
				institutional placement in the absence of community alternatives. The level of
				care determination must be completed and the beneficiary deemed eligible for
				ICF/MR level of care prior to receiving ACS Waiver services.
Recertification, based on intellectual and behavioral
				assessments submitted by the provider at appropriate age milestones, will be
				performed by DDS to determine the beneficiary's continuing need for an ICF/MR
				level of care.
The annual level of care determination is made by a QMRP
				(physician).
230.200
Levels of Support
Coverage is provided within three levels of support. Levels of
				support are defined as pervasive, extensive and limited and are based on the
				amount of need for assistance. The beneficiary can move from one level of
				support to another if there is documentation supporting the need for a higher
				degree of support. No exceptions are made if documentation does not support the
				beneficiary's need for a higher level of support.
Once the pervasive level of support is reached and all other
				funding sources have been accessed, if the provider cannot assure the health,
				safety and welfare of the beneficiary in the community, case closure
				proceedings are initiated.
230.211
Pervasive Level of
			 Support
The pervasive level of support is defined as needs that require
				constant supports provided across environments that are intrusive, long term
				and include a combination of any available waiver supports provided 24 hours a
				day, 7 days a week for 365 days a year.
A. This level may include persons in need of
			 priority consideration who are currently served through Act 609; Department of
			 Human Services (DHS) integrated supports; are civil commitments; are children
			 in custody of the Division of Children and Family Services (DCFS) and who are
			 receiving services through the Children's Adolescents Special Services
			 Programs; Intermediate care facility/mental retardation; nursing facilities and
			 persons who have compulsive behavior disorders.
B. People who meet the pervasive level of
			 support definition are determined eligible based on the Inventory for Client
			 and Agency Planning (ICAP) assessment process.
C. Procedures for requesting pervasive level
			 of support:
1. To request pervasive level of
			 support, the Case Manager must submit the following items to the DDS Waiver
			 Specialist:
a. Documentation of changes in
			 medical, behavioral or other condition that would justify the need for
			 pervasive level of support. Include all incident reports.
b. Copy of the current person centered
			 service plan.
c. Copy of the
			 person's case management and supportive living staff notes for the past year if
			 request is due to behavior or medical.
d. If the reason for pervasive level of
			 support is in whole or in part due to behavior issues, a copy of the most
			 recent psychological information on behavioral intervention efforts to include:
(1) A functional behavior analysis of
			 inappropriate behavior including possible antecedents
(2) Description of inappropriate behaviors
			 and consequences
(3) Information
			 related to increases or decreases in inappropriate behavior including time
			 involved and frequency
(4) Positive
			 programming changes to include a description of the behaviors attempting to be
			 established to replace the inappropriate behavioral expression.
e. Copy of the computer generated
			 or signed narrative report for the ICAP results which includes:
(1) ICAP Domain scores (age scores and
			 standard scores)
(2) Information on
			 problem behaviors recorded in the ICAP
(3) ICAP Maladaptive Behavior Index
			 Scores
(4) ICAP Service
			 Score/Level
(5) The name and
			 relationship of respondent must be clearly noted.
(6) The name and credentials of the person
			 administering and writing the report must be clearly noted.
2. Upon receipt of a
			 request for pervasive level of support a. The DDS Waiver Specialist will check
			 with DDS Licensure unit to determine if any incident reports have been filed
			 related to the beneficiary. If incident reports have been filed, a copy will be
			 obtained for the plan of care meeting.
b. The
			 DDS Waiver Area Manager will check the Incident Reporting Information System
			 (IRIS) to see if reports have been filed related to the beneficiary. If any
			 reports have been filed on IRIS, a summary will be compiled for the plan of
			 care meeting. The summary will include any variances between the submitted
			 reports and those found or not found in the DDS reporting systems.
c. The DDS Waiver Specialist will check the
			 Medicaid Management Information System (MMIS) and all waiver prior
			 authorizations issued and payments for waiver services for the past year. The
			 case manager will be required to justify any under utilization.
3. If the request packet is not
			 complete, it will not be accepted. Retroactive approval will not be granted on
			 pervasive level of support although emergency approval, pending receipt of
			 required documents and determination, may be obtained from the Assistant
			 Director of Adult and Waiver Services. Emergency requests may be made via
			 secure e-mail. For emergency requests, all the required documentation listed in
			 this rule must be submitted within two working days. If the documentation does
			 not support there was an emergency, the emergency approval will be suspended or
			 rescinded.
4. If the Plan of Care
			 Review Team cannot make a decision on pervasive level of support and needs
			 additional information, they will request assistance from the DDS Psychological
			 Team.
5. If assistance is requested
			 from the DDS Psychological Team, they will convene within five working days
			 following the Plan of Care Team meeting.
6. If the Plan of Care Review Team requires
			 additional information based on incident reports or IRIS summaries, the
			 timeframe for approving pervasive level of support will start over.
7. All requests for pervasive level of
			 support will be reviewed at the weekly Plan of Care Review Team
			 meetings.
230.212
Extensive Level of
			 Support
The extensive level of support is defined as needs that require
				daily supports in one or more environments (work, home or community). Supports
				are less intrusive than the pervasive supports and may require a schedule of
				weekly supports that may be needed daily, but less than 24 hours a day, seven
				days a week.
230.213
Limited Level of Support
The limited level of support is defined as needs that are
				anticipated to be consistent for a foreseeable future period of time,
				individually time-limited and may be intermittent in nature, subject to
				re-evaluation every 12 months. This level of support is less because of
				parental support, group settings and community assistance available to the
				beneficiary.
230.300
Comprehensive Diagnosis and Evaluation
A comprehensive diagnosis and evaluation (D&E) must be
				administered in order to determine that applicants are persons with a
				developmental disability prior to receiving ACS Waiver services from the
				DDS.
The comprehensive diagnosis and evaluation includes a series of
				examinations and observations performed or validated and approved by
				professionals leading to conclusions and findings.
The examinations and/or assessments include, but are not
				limited to:
A. A thorough medical
			 examination and other evaluations deemed necessary by the physician
B. A psychological assessment
C. A social history/sociological
			 examination
D. An educational
			 assessment, if applicable
E. An
			 appraisal of adaptive behavior
F.
			 All other examinations, assessments and evaluations necessary to describe the
			 beneficiary's needs
G. Areas of
			 Need form
Failure to submit the reassessments in advance of eligibility
				expiration date will result in the denial of case management reimbursement for
				the period the determination is overdue. Failure to obtain any required
				eligibility determination, whether initial or subsequent time-bound
				reassessments, may result in the beneficiary's case being closed.
When a beneficiary's case has been closed, the affected person
				must make a new request for services through the waiver program intake process
				in order for services to continue. This will be considered a new application to
				the waiver program.
230.400
Person Centered Service
			 Plan
During the initial three months of DDS ACS waiver services, a
				beneficiary receives services based on a DDS pre-approved initial person
				centered service plan that provides for case management at the prevailing rate,
				up to three months; and supportive living services for direct care supervision
				at a rate of $100.00 per month, up to three months. It may include transitional
				funding when the person is transitioning from an institution to the community.
				Persons residing in a Medicaid reimbursed facility may receive case management
				the last 180 consecutive days of the institutional stay.
NOTE: The fully developed person centered service plan
				may be submitted, approved and implemented prior to the expiration of the
				initial person centered service plan. The initial plan period is simply the
				maximum time frame for developing, submitting, obtaining approval from DDS and
				implementing the person centered service plan. An extension may be granted when
				there is supporting documentation justifying the delay.
Prior to expiration of the interim plan of care, each
				beneficiary eligible for ACS waiver services must have an individualized,
				specific, written person centered service plan developed by a multi-agency team
				and approved by the DDS authority. The members of the team will determine
				services to be provided, frequency of service provision, number of units of
				service and cost for those services while ensuring the beneficiary's desired
				outcomes, needs and preferences are addressed. Team members and a physician,
				via the DDS 703 form, certify the beneficiary's condition (level of care) and
				appropriateness of services initially and at the annual continued stay review.
				The person centered service plan is conducted once every 12 months in
				accordance with the continued stay review date or as changes in the
				beneficiary's condition require a revision to the person centered service
				plan.
The person centered service plan must be designed to assure
				that services provided will be:
A.
			 Specific to the beneficiary's unique circumstances and potential for personal
			 growth.
B. Provided in the least
			 restrictive environment possible.
C. Developed within a process assuring
			 participation of those concerned with the beneficiary's welfare. Participants
			 of the multi-agency team included the beneficiary's chosen case manager, the
			 beneficiary or legal representative and additional persons whom the beneficiary
			 chooses to invite to the planning meeting, as long as all rules pertaining to
			 confidentiality and conflict of interest are met. If invited, the DDS Waiver
			 Specialist attends the planning meetings randomly, in an effort to assure an
			 annual 10% attendance ratio. The DDS Waiver Specialist must attend all planning
			 meetings if the beneficiary is believed to be eligible for the pervasive level
			 of support. Mandatory attendance by the case manager is required to assure the
			 written person centered service plan meets the requirements of regulations, the
			 desires of the beneficiary or legal representative, is submitted timely, and is
			 approved by DDS prior to service delivery.
D. Monitored and adjusted to reflect changes
			 in the beneficiary's needs. A person centered service plan revision may be
			 requested at any time the beneficiary's needs change.
E. Provided within a system which safeguards
			 the beneficiary's rights.
F.
			 Documented carefully, with assurance that appropriate records will be
			 maintained.
G. Will assure the
			 beneficiary's and others' health and safety. The person centered service plan
			 development process identifies risks and makes sure that they are addressed
			 through backup plans and risk management agreements. A complete description of
			 backup arrangements must be included in the person centered service plan.
230.410
Person
			 Centered Service Plan Required Documentation
A. General Information Identification
			 information must include:
1. Beneficiary's
			 full name and address
2.
			 Beneficiary's Medicaid number
3.
			 Guardian or Power of Attorney with an address (when applicable)
4. Number of individuals with MR/DD residing
			 in home of waiver beneficiary and type of residence.
5. Physician Level of Care
			 Certification
6. Names, titles and
			 signatures of the multi-agency team members responsible for the development of
			 the beneficiary's person centered service plan.
B. Budget Sheet, Worksheets and Provider
			 Information Information must include:
1.
			 Identification of the type waiver services to be provided
2. The name of the provider delivering the
			 service
3. Total amount by
			 service.
4. Total plan amount
			 authorized
5. Beginning and ending
			 date for each service
6. Supported
			 Living Array worksheet listing units and total cost by service and level of
			 support
7. Adaptive Equipment,
			 Environmental Modifications, Specialized Medical Supplies, Supplemental
			 Support, and Community Transition worksheets listing units and total cost by
			 service
8. Provider Information
			 sheet showing case management provider, case manager, supportive living
			 provider, and direct care supervisor.
C. Narrative justification for the revision
			 to the initial plan of care must, at a minimum justify the need for requested
			 services. Narrative justification for annual continued stay reviews must
			 address utilization of services used or unused within the past year, justify
			 new services requested and address risk assessment.
D. The person centered service plan must
			 include:
1. Identification of individual
			 objectives.
2. Frequency of review
			 of the objectives.
3. List of
			 medical and other services, including waiver and non-waiver services necessary
			 to obtain expected objectives.
4.
			 Expected outcomes including any service barriers
E. Product and service cost effectiveness
			 certification statement, with supporting documentation, certifying that
			 products, goods and services to be purchased meet applicable codes and
			 standards and are cost competitive for comparable quality.
240.000
PRIOR AUTHORIZATION
ACS waiver services require prior authorization by the Division
				of Developmental Disabilities Services.
In the absence of prior
				authorization, reimbursement will be denied and will not be approved
				retroactively.
241.000
Approval Authority
For the purpose of person centered service plan approvals, DDS
				is the Medicaid authority.
A. The DDS
			 prior authorization process requires that all pervasive level of support
			 service plans, problematic service plans, or plans not clearly based on
			 documented need must have approval by DDS Plan of Care Review Team.
1. Problematic is based on individual
			 circumstances, a change in condition, or a new service request as determined by
			 the DDS Waiver Specialist or by request of the case manager.
2. The DDS Plan of Care Review Team consists
			 of the DDS Waiver Program director or designee, DDS Waiver Area Managers, DDS
			 Psychology Team member and other expert professionals such as nurses,
			 physicians or therapists. The DDS Waiver Specialist is responsible for
			 presenting the case to the team. The waiver participant or legal representative
			 is permitted to attend the meeting and present supporting evidence why the
			 services requested should be approved, as long as all rules pertaining to
			 confidentiality and conflict of interest are met.
3. The DDS Waiver Specialist must conduct an
			 in-home visit for all pervasive level of support requests and may conduct an
			 in-home visit for problematic service plans or plans that are not based on
			 documented needed. Failure of the beneficiary or legal representative to permit
			 DDS from conducting the in-home visit may result in the denial of service
			 request and may result in case closure.
B. All extensive and limited service plans
			 will be subject to a local level approval process.
C. All waiver services must be needed to
			 prevent institutionalization.
D.
			 All beneficiaries receiving medications must also receive appropriate support
			 in the management of medication(s). The use of psychotropic medications for
			 behavior will require the development, implementation and monitoring of a
			 written positive behavior plan.
E.
			 Service requests that will supplant Department of Education responsibilities
			 WILL NOT be approved. This includes voluntary decisions to withdraw from, or
			 never enter the Department of Education, public school system. The waiver does
			 not provide educational services, including educational materials, equipment
			 supplies or aids.
F. All person
			 centered service plans are subject to review by a qualified physician and
			 random audit scrutiny by DDS Specialists, DDS Area Managers, DDS Licensure
			 staff or DMS Quality Assurance staff. In addition, the following activities
			 will occur:
1. Review of provider standards
			 and actions that provide for the assurance of a person's health and
			 welfare
2. Monitoring of compliance
			 with standards for any state licensure or certification requirement for persons
			 furnishing services provided under this waiver
3. Assurance that the requirements are met on
			 the date that the service is furnished
4. Quality assurance reviews by DDS staff
			 include announced and unannounced quarterly on-site home visits.
5. Random review equal to a percent as
			 prescribed by DDS Licensure Unit's certification policy.
G. All service requests are subject to review
			 by DDS and may necessitate the gathering and submission of additional
			 justification, information and clarification before prior approval is made. In
			 this event, it is the primary responsibility of the case management provider,
			 with cooperation from the procurement source, to satisfy the request(s) within
			 the prescribed time frames.
H. It
			 is the responsibility of the case management services provider with cooperation
			 from the direct services providers to ensure that all requests for services are
			 submitted in a timely manner to allow for DDS prior authorization activities
			 prior to the expiration of existing plans or expected implementation of
			 revisions.
I. Initially, a
			 beneficiary receives up to three months of DDS ACS waiver services based on a
			 DDS pre-approved interim person centered service plan. The pre-approved interim
			 plan will include case management and supportive living service for direct care
			 supervision and may include community transition services when the person is
			 transitioning from an institution to the community. For transitional case
			 management, the three month interim plan begins with the date of discharge.
1. At any time during the initial three
			 months or transitional case management period, the case manager will complete
			 the planning process and submit a detailed person centered service plan that
			 identifies all needed, medically necessary services for the remainder of the
			 plan of care year. Once approval is obtained, these services may be
			 implemented.
2. Waiver services
			 will not be reimbursed for any date of service that occurs prior to the date
			 the beneficiary's person centered service plan is approved, the date the
			 beneficiary is determined to be ICF/MR eligible, or the date the beneficiary is
			 deemed Medicaid waiver eligible, whichever date is last.
3. All changes of service or level of support
			 revisions must have prior authorization. Services that are not prior authorized
			 will not be reimbursed.
J. Emergency approvals may be obtained via
			 telephone, facsimile or e-mail, with retroactive reimbursement permitted as
			 long as the notice of emergency, with request for service change, is received
			 by DDS within 24 hours from the time the emergency situation was known. All
			 electronically transmitted requests for emergency services must be followed
			 with written notification and requests must be supported with documented proof
			 of emergency. Failure to properly document proof of emergency shall result in
			 approval being rescinded.
250.000
REIMBURSEMENT
251.000
Method of Reimbursement
The reimbursement rates for DDS ACS waiver services will be
				according to the lesser of the billed amount or the Title XIX (Medicaid)
				maximum for each procedure.
The maximum supportive living daily rate is inclusive of
				administration costs that cannot in any event exceed 20% of the total
				supportive living array for a beneficiary.
If fringe benefits exceed 25%, documentation must be submitted
				with person centered service plan and budget request. Fringe benefits cannot
				exceed 32%.
The administration and fringe costs are subject to audit and
				must be documented to support the rate charged.
252.000
Rate Appeal Process
A provider may request reconsideration of a program decision by
				writing to the Assistant Director, Division of Medical Services. This request
				must be received within 20 calendar days following the application of policy or
				procedure or the notification of the provider of its rate. Upon receipt of the
				request for review, the Assistant Director will determine the need for a
				program or provider conference and will contact the provider to arrange a
				conference if needed. Regardless of the program decision, the provider will be
				afforded the opportunity for a conference, if he or she wishes, for a full
				explanation of the factors involved and the Program decision. Following review,
				the Assistant Director will notify the provider of the action to be taken by
				the division within 20 calendar days of receipt of the request for review or
				the date of the program and/or provider conference.
When the provider disagrees with the decision made by the
				Assistant Director of the Division of Medical Services, the provider may appeal
				the question to a standing Rate Review Panel established by the Director of the
				Division of Medical Services. The rate review panel will include one member of
				the Division of Medical Services, a representative of the provider association
				and a member of the Department Human Services (DHS) management staff, who will
				serve as chairperson.
The request for review by the rate review panel must be
				postmarked within 15 calendar days following the notification of the initial
				decision by the Assistant Director of the Division of Medical Services. The
				rate review panel will meet to consider the question(s) within 15 calendar days
				after receipt of a request for such appeal. The panel will hear the questions
				and a recommendation will be submitted to the Director of the Division of
				Medical Services.
260.000
BILLING PROCEDURES
261.000
Introduction to Billing
DDS ACS waiver providers use the CMS-1500 claim form to bill
				the Arkansas Medicaid Program on paper for services provided to eligible
				Medicaid beneficiaries. Each claim should contain charges for only one
				beneficiary.