New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 635 - General Quality Control and Administrative Requirements Applicable to Programs, services or Facilities Funded or Certified by the Office for People With Developmental Disabilities › Subpart 635-10 - Provision of Home and Community-Based Waiver Services › Section 635-10.4 - Allowable services

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
Case management services.
(1)
				  Every person approved for participation in the HCBS waiver, shall be assisted
				  by a specific case manager chosen by him or herself or his/her advocate (see
				  glossary), regardless of the type or amount of service(s) received.
(2) The chosen case manager is responsible
				  for assisting the person and/or his/her advocate, as needed, to create and
				  sustain an individualized service environment by developing, implementing,
				  reviewing and revising the person's individualized service plan. To the extent
				  possible, providers of case management services shall attempt to ensure the
				  avoidance of a conflict of interest between the provision of case management
				  services and other services in which the person is participating or
				  receiving.
(3) Case management
				  services includes the following categories of activities:
(i) Assessment-actions taken to determine a
				  person's functional status, service needs, personal goals and preferences. This
				  category includes:
(a) Arranging for and
				  obtaining any needed clinical assessments to determine the person's functional
				  status, service needs and recommendations for interventions.
(b) Interviews with the person, the person's
				  advocate and service providers.
(c)
				  Evaluating the information obtained from clauses (
a
) and
				  (
b
) of this subparagraph with the person and his/her advocate
				  to reach consensus on the person's functional status, service needs,
				  recommendations for interventions, and the person's personal goals and
				  preferences in order to assist the person in choosing the types of services,
				  supports, and activities that create the individualized service environment and
				  the resulting individualized service plan.
(d) Ensuring the assessment of, at least
				  annually, the person's specific needs relative to his or her capacity to
				  evacuate the home in a timely manner in the event of a fire emergency. Said
				  assessment shall take into account the person's ability to walk, to follow
				  directions and the circumstances of his/her home (
i.e.,
layout, number of occupants and their needs relative to fire evacuation, and
				  availability of assistance.)
(ii) Service planning and
				  coordination-actions taken to develop the individualized service plan (based on
				  the assessment process), to coordinate service provision including:
(a) coordination of the services, supports
				  and activities identified as components of the individualized service
				  plan;
(b) completion of a written
				  individualized service plan; and
(c) ensuring the performance of the as-needed
				  reviews of the individualized service plan and documenting the
				  outcomes.
(iii) Linkage
				  and referral-the process of assisting the person and his/her advocate to
				  identify and access specific service providers by:
(a) providing information on services and
				  supports;
(b) making referral and
				  placement arrangements and ensuring access; and
(c) accompanying the person to the new
				  service or support to participate in the placement process.
(iv) Follow-up and monitoring-actions taken
				  to oversee the person's participation in the needed/desired HCBS waiver
				  services, supports and activities, according to the individualized service
				  plan. This includes taking into account the changing needs and personal goals
				  of the person and taking any actions necessary to ensure the person's stability
				  in, and ongoing benefit from his/her individualized service environment. These
				  actions include:
(a) making ongoing
				  arrangements for the person's use of services and supports;
(b) maintaining ongoing contact with the
				  person and his/her advocate and service providers, and intervening when the
				  person, his/her advocate, or a provider identifies a problem;
(c) accompanying the person to the service or
				  other problem source to aid the person by assisting in communication and
				  resolution of the issues. It may also include the representation of the person
				  where the person and his/her advocate are unable to present their
				  case;
(d) ensuring that the actions
				  and recommendations relative to addressing the person's fire safety needs, as
				  determined during the assessment pursuant to clause (i)(
d
) of
				  this paragraph, are carried out as specified in the person's individualized
				  service plan;
(e) performing the
				  as-needed reviews of the individualized service plan and the ICF/IID level of
				  care determination and documenting the outcomes; and
(f) maintaining an up-to-date written
				  individualized service plan.
(4) A provider of case management services
				  shall be incorporated pursuant to the New York State Not-for-Profit Corporation
				  Law, or shall be a governmental entity and shall demonstrate to OPWDD, prior to
				  certification, that the applicable case management provider has the capacity to
				  deliver the full range of case management services, in a competent manner, to
				  the persons likely to be served by the provider. There shall be:
(i) Documentation that any parties delivering
				  case management hold at least a bachelor's degree and have at least one year's
				  practical experience in serving person's with developmental disabilities or
				  hold a high school diploma, have at least one year's practical experience in
				  serving persons with developmental disabilities and have completed an
				  OPWDD-approved competency-based training program in case management.
(ii) A process in place to provide adequate
				  supervision and oversight of the case manager using personnel with greater
				  credentials than the minimal qualifications for case managers.
(iii) A means made available to all persons
				  receiving case management services and/or their advocates by which complaints
				  may be registered and resolved without threat of reprisal, including the
				  selection of a new case manager or another case management
				  agency.