Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 05 - Developmental Disabilities Services › Rule 016.05.24-001 - Community and Employment Supports (CES) Agency Standards

Current through Register Vol. 49, No. 6, June, 2024
Subchapter 1.
General
.
101.
Authority
.
These standards are promulgated under the authority of Ark.
				Code Ann. §
										20-76-201, and Ark. Code Ann.
				§§
										20-48-101 to -1108.
102.
Purpose
.
The purpose of these standards is to:
(1) Serve as the minimum standards for
			 community providers delivering services to beneficiaries enrolled in the
			 Arkansas 1915(c) home and community-based waiver number AR.0188, which is known
			 as the Community and Employment Support Waiver (CES Waiver); and
(2) Ensure the health and safety of
			 beneficiaries who are enrolled in the CES Waiver.
103.
Definitions
.
(a) "Adverse agency action" means:
(1) A denial of an application for CES Waiver
			 Service certification;
(2) Any
			 enforcement action taken by DDS pursuant to sections 803 through 807;
			 and
(3) Any other adverse
			 regulatory action or claim covered by the Medicaid Fairness Act, Ark. Code Ann
			 §§
											20-77-1701 to -1718.
(b) "Alternative living home"
			 means beneficiary residential setting that is not owned, leased, or controlled
			 by the beneficiary, the beneficiary's legal guardian, or a family member of the
			 beneficiary.
(c) "Applicant" means
			 an applicant for CES Waiver Service certification.
(d) "Beneficiary" means an individual
			 receiving one (1) or more CES Waiver Services.
(e) "Business Day" means Monday through
			 Friday, except for any day that is recognized as a holiday by the State of
			 Arkansas.
(f) "Change of ownership"
			 means any fifty percent (50%) or greater change in the financial interests,
			 governing body, operational control, or other operational or ownership
			 interests of a Provider within a twelve (12) month period.
(g) "CES Waiver" means the Arkansas 1915(c)
			 home and community-based waiver number AR.0188, which is known as the Community
			 and Employment Support Waiver.
(h)
			 "CES Waiver Service" means one of the following services each as defined in
			 section 220.000 of the Home and Community-Based Services for Client with
			 Intellectual Disabilities and Behavioral Health Needs Medicaid Manual and the
			 CES Waiver:
(1) Respite;
(2) Supported Employment;
(3) Supportive Living;
(4) Specialized Medical Supplies;
(5) Adaptive Equipment;
(6) Community Transition Services;
(7) Consultation;
(8) Environmental Modifications;
			 and
(9) Supplemental
			 Support.
(i) "Chemical
			 restraint" means the use of medication or any drug that:
(1) Is administered to manage a beneficiary's
			 behavior;
(2) Has the temporary
			 effect of restricting the beneficiary; and
(3) Is not a standard treatment for the
			 beneficiary's medical or psychiatric condition.
(j) "DDS" means the Arkansas Department of
			 Human Services, Division of Developmental Disabilities Services, or its
			 delegate.
(k) "DMS" means the
			 Arkansas Department of Human Services, Division of Medical Services.
(l) "Directed in-service training plan" means
			 a plan of action that:
(1) Provides training
			 to a Provider to correct non-compliance with these standards;
(2) Establishes the topics covered and
			 materials used in the training;
(3)
			 Specifies the length of the training;
(4) Specifies the employees required to
			 attend the training; and
(5) Is
			 approved by DDS.
(m)
(1) "Employee" means an employee or other
			 agent of a Provider who has or will have direct contact with a beneficiary or
			 their personal property or funds, including without limitation any employee,
			 independent contractor, sub-contractor, intern, volunteer, trainee, or
			 agent.
(2) "Employee" does not mean
			 an independent contractor if:
(A) The
			 independent contractor does not assist in the day-to-day operations of
			 Provider; and
(B) The independent
			 contractor has no beneficiary contact.
(n)
(1)
			 "Licensed professional" means a person who holds a State of Arkansas
			 professional certificate or license in good standing that is operating within
			 the scope of practice of their license or certification.
(2) "Licensed professional" includes without
			 limitation the following independently licensed or certified professionals:
			 general contractor, physician, psychiatrist, psychologist, social worker,
			 psychological examiner, parent educator, communication and environmental
			 control specialist, behavior support specialist, professional counselor,
			 behavioral analyst, master social worker, licensed practical nurse, registered
			 nurse, speech-language pathologist, dietician, occupational therapist, physical
			 therapist, and recreational therapist.
(o)
(1)
			 "Market" means the accurate and honest advertisement of a Provider that does
			 not also constitute an attempt to solicit.
(2) "Market" includes without limitation:
(A) Advertising using traditional
			 media;
(B) Distributing brochures
			 or other informational materials regarding the services offered by a
			 Provider;
(C) Conducting tours of a
			 Provider to interested beneficiaries and their families;
(D) Mentioning services offered by a Provider
			 in which a beneficiary or their family might have an interest; and
(E) Hosting informational gatherings during
			 which the services offered by a Provider are described.
(p) "Mechanical restraint" means
			 the use of any device attached or adjacent to a beneficiary that:
(1) The beneficiary cannot easily remove;
			 and
(2) Restricts the beneficiary's
			 freedom of movement.
(q)
			 "Medication error" means any one of the following:
(1) Loss of medication;
(2) Unavailability of medication;
(3) Falsification of medication
			 logs;
(4) Theft of
			 medication;
(5) Missed dose of
			 medication;
(6) Incorrect
			 medications administered;
(7)
			 Incorrect dose of medication administered;
(8) Incorrect time of medication
			 administration;
(9) Incorrect route
			 of medication administration; and
(10) The discovery of an unlocked medication
			 container that is always supposed to be locked.
(r) "Mental health professional" or "MHP"
			 means a person who holds an Arkansas professional license in good standing to
			 provide one or more of the services set out in the Counseling Services Medicaid
			 manual.
(s) "Non-clinical treatment
			 plan" means a Provider's written, individualized service plan for a
			 beneficiary, outlining the specific method and goals for CES Waiver Services
			 delivery by Provider.
(t) "PASSE"
			 means a beneficiary's assigned Provider-led Arkansas Shared Savings
			 Entity.
(u) "PCSP" means a
			 person-centered service plan, which is a written, individualized service and
			 support plan developed by the beneficiary's PASSE care coordinator, which sets
			 out the home and community-based services to be received by a
			 beneficiary.
(v) "Plan of
			 correction" means a plan of action that:
(1)
			 Provides the steps a Provider must take to correct noncompliance with these
			 standards;
(2) Establishes a
			 timeframe for each specific action included in the plan; and
(3) Is approved by DDS.
(w) "Provider" means an individual,
			 organization, or entity certified to provide one or more CES Waiver
			 Services.
(x) "Provider owned,
			 leased, or controlled CES Waiver Service residential setting" means any
			 residential setting that is owned, leased, or controlled by a Provider within
			 the meaning of the CBS Home and Community-Based Services Settings Final Rule,
			 79 Federal Register 2948 (2014).
(y)
(1)
			 "Restraint" means the application of force for the purpose of restraining the
			 free movement of a beneficiary, which includes without limitation any chemical
			 restraint and mechanical restraint.
(2) "Restraint" does not include:
(A) Briefly holding, without undue force, a
			 beneficiary to calm or comfort the beneficiary; or
(B) Holding a beneficiary's hand to safely
			 escort the beneficiary from one area to another.
(z) "Risk mitigation plan" means
			 an individualized risk management plan developed by a beneficiary's PASSE care
			 coordinator that outlines a beneficiary's risk factors and the action steps
			 that must be taken to mitigate those risks.
(aa) "Seclusion" means the involuntary
			 confinement of a beneficiary alone or in a room or area from which the
			 beneficiary is physically prevented from leaving.
(bb) "Serious injury" means any injury to a
			 beneficiary that:
(1) May cause
			 death;
(2) May result in
			 substantial permanent impairment;
(3) Requires hospitalization; or
(4) Requires the attention of:
(A) An emergency medical
			 technician;
(B) A paramedic;
			 or
(C) An emergency room.
(cc)
(1) "Solicit" means when a Provider
			 intentionally initiates contact with a beneficiary (or their family) that is
			 currently receiving services from another provider and Provider is attempting
			 to persuade the beneficiary or their family to switch to or otherwise use the
			 services of Provider.
(2) "Solicit"
			 includes without limitation the following acts to induce a beneficiary or their
			 family by:
(A) Contacting a beneficiary or the
			 family of a beneficiary that is currently receiving services from another
			 provider;
(B) Offering cash or gift
			 incentives to a beneficiary or their family;
(C) Offering free goods or services not
			 available to other similarly situated beneficiaries or their
			 families;
(D) Making negative
			 comments to a beneficiary or their family regarding the quality of services
			 performed by another provider;
(E)
			 Promising to provide services in excess of those necessary;
(F) Giving a beneficiary or their family the
			 false impression, directly or indirectly, that Provider is the only provider
			 that can perform the services desired by the beneficiary or their family;
			 or
(G) Engaging in any activity
			 that DDS reasonably determines to be "solicitation."