New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 671 - HCBS Waiver Community Residential Habilitation Services for Persons with Developmental Disabilities › Section 671.5 - Allowable services

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
Principles of compliance.
(1)
				Allowable community residential habilitation services by an authorized provider
				(see glossary) are those appropriately supervised (see glossary) activities,
				interventions and therapies necessary for the maximum reduction of functional
				and/or behavioral deficits associated with the person's developmental
				disability.
(2) Services shall be
				designed and implemented to train, or develop skills, capabilities or knowledge
				appropriate to enhance or improve a person's independence, lessen dependence or
				minimize loss of functioning or adaptive capacity.
(3) The expressed treatment goal of community
				residential habilitation services shall be to promote and encourage outcomes
				related to independence, integration, individualization, and
				productivity.
(4) Categories of
				allowable services.
(i) Health skills
				training services. Activities, interventions and therapies designed to promote
				independence in personal health care by increasing the person's awareness of
				his or her physical health status and the resources required to maintain
				physical health, including, but not limited to, regular medical and dental
				appointments, basic first aid skills and basic knowledge of proper nutritional
				habits. Also included is training on topics such as disease
				prevention.
(ii)
				Self-administration of medication training services. Activities, interventions
				and/or therapies designed to develop skills and enhance capacity (or limit
				regression) in the functional areas including, but not limited to,
				understanding the role and effect of medication, the importance of adherence to
				any medication regimen, and the performance of the actual behavior(s) necessary
				to actually take medication in accordance with a prescribed regimen. While not
				including the act of prescribing, such training does include activities related
				to reviewing the need for, and appropriateness of the person's medication
				regimen with his/her physician or health care provider.
(iii) Socialization skills training services.
				Activities, interventions and therapies which are designed to assist the person
				in developing skills and enhancing capacities that diminish tendencies toward
				isolation and withdrawal by assisting the person in the acquisition or
				development of social and interpersonal skills. "Socialization" is an activity
				meant to improve or maintain a person's capacity for social involvement by
				providing opportunities for the application of social skills. This occurs
				through resident and staff interaction in the program and through exposure with
				staff to opportunities in the community. Modalities used in socialization
				include individual and group counseling and behavior intervention.
(iv) Communication skills training services.
				Activities, interventions and therapies designed to develop skills or enhance
				capacity (or limit regression) in the functional areas including; but not
				limited to expressive language; receptive language; use of adaptive/specialized
				communication devices; and listening skills.
(v) Functional skills training services.
				Activities, interventions and therapies which are designed to develop skills
				and enhance capacities (or limit regression) to engage in the primary
				activities of daily life. Services are provided by addressing areas of
				functioning such as: dressing, personal hygiene and grooming, selection and/or
				preparation of food, cleaning and washing of clothes, maintenance of the
				personal environment, budgeting and money management, education in general
				health, family planning and use of community resources such as public
				transportation. Training is intended to increase those competencies needed by
				the individual to live in his or her chosen environment.
(vi) Assertiveness/self-advocacy skills
				training services. Activities, interventions, and therapies which promote the
				person's ability to assess and utilize his or her strengths and capacity to
				make life status changes and to increase self-awareness about his or her values
				and preferences. Training also focuses on increasing a person's ability to
				respond to medical, safety and other personal problems. Activities are also
				intended to improve communication skills and facilitate appropriate
				interpersonal behavior.
(vii)
				Behavior skills training services. Activities, interventions and therapies
				designed to develop skills and enhance capacities (or limit regression) in the
				functional areas including; but not limited to, interpersonal behavior;
				minimizing/eliminating self-injurious behavior; minimizing/eliminating
				aggressive behavior; and conducting oneself appropriately in various community
				settings.
(viii) Community
				integration and resource utilization skills training services. Activities,
				interventions and therapies which are designed to help the person identify
				skills and community supports necessary for specific environments, to assess
				their skills and strengths in relationship to meeting environmental demands, to
				access resources available to help the person, and to develop a natural support
				system by assessing social, educational and recreational opportunities and
				learning how to make choices.
(ix)
				Motor skills training services. Activities, interventions and therapies
				designed to develop a person's skills or enhance capacity (or limit regression)
				in the functional areas including, but not limited to, mobility in
				walking/sitting/standing; fine and gross motor activities; and use of adaptive
				mobility equipment.
(x) Skills
				development training services. Activities, interventions and therapies which
				enhance utilization of the skills necessary to undertake employment or pursue
				education opportunities. This may include developing and enhancing skills
				related to securing appropriate clothing, scheduling, work-related symptom
				management, and work readiness training.
(5) Community residential habilitation
				services. Effective July 1, 1996, the provider of community residential
				habilitation services in a supervised community residence, shall be responsible
				for any necessary transportation to and from physician, dentist, and other
				clinical services, and any other transportation appropriate to the person's
				participation in community-based out-of-residence activities planned for or
				sponsored by the residence. Nothing herein shall be interpreted as precluding
				the accessing of separate Medicaid claiming for emergency/nonemergency
				ambulance services (as defined in 18 NYCRR 505.10) necessitated by the person's
				medical condition.
(6) The provider
				of community residential habilitation services in a supervised community
				residence is responsible for the cost of:
(i)
				services that are necessary to meet the needs of individuals while in
				residence;
(ii) services that,
				prior to August 1, 2004, could have been met by home health aide or personal
				care services separately billed to Medicaid;
(iii) services that, prior to October 1,
				2015, could have been met by home health aide or personal care services
				separately billed to Medicaid, with those services provided in the community on
				weekday evenings or anytime on the weekend, unless the weekday evening or
				weekend services are established to support the individual in an integrated job
				site; and
(iv) services specified
				in paragraph (7) of this subdivision that, prior to October 1, 2015, may have
				been separately billed to Medicaid.
(7) Effective October 1, 2015, residential
				habilitation services in a supervised CR include the following clinical
				services delivered to an individual that are directly related to the
				individual's residential habilitation plan:
(i) nutrition services that consist of meal
				planning and monitoring, assessment of dietary needs and weight changes,
				development of specialized diets, diet education, and food safety and
				sanitation training;
(ii)
				behavioral intervention and support services delivered by a licensed
				psychologist, licensed clinical social worker, or behavioral intervention
				specialist that consist of behavioral assessment and intervention planning,
				delivery and review or monitoring of behavioral interventions, and behavioral
				support services provided pursuant to section
				633.16 
				of this Title; and
(iii) nursing
				services that consist of:
(a) training and
				supervision of direct support staff who perform health-related and delegated
				nursing tasks that include, but are not limited to, observation for illness and
				injury, medication administration, tube feeding, and colostomy care;
(b) development and monitoring of written
				plans of nursing services that identify interventions direct support staff
				carry out to address individuals' health care needs;
(c) availability of nursing supervision, by a
				registered nurse, on site or by telephone, at all times to respond to direct
				support staff in order to address individuals' ongoing and immediate health
				care needs;
(d) coordination of
				individuals' health care services, including, but not limited to, arranging for
				needed medical appointments and diagnostic testing, interfacing on behalf of
				individuals with community-based healthcare providers, and ensuring that
				treatments are carried out in accordance with physicians' orders; and
(e) provision of direct nursing care that
				cannot be delegated to direct support staff and that is available within the
				staffing plan at the residence and/or is not available through other
				sources.
(8)
				The provider of community residential habilitation services in a supportive CR
				is responsible for the cost of services that, prior to October 1, 2015, could
				have been met by a home health aide or personal care services separately billed
				to Medicaid; either
(i) at the residence at
				any time; or
(ii) in the community
				on weekday evenings or anytime on the weekend, unless the weekday evening or
				weekend services are established to support the individual in an integrated job
				site.