A. Staffing
The Provider agrees that he or she will maintain adequate
staffing levels to ensure timely and consistent delivery of services to all
beneficiaries for whom they have accepted a Living Choices Assisted Living
Waiver Plan of Care.
The Provider agrees:
1. Personnel responsible for direct service
delivery will be properly trained and in compliance with all applicable
licensure requirements. The Provider agrees to require personnel to participate
in any appropriate training provided by, or requested by, the Department of
Human Services. The Provider acknowledges the cost of training courses for
certification and/or licensure is not reimbursable through DHS.
2. Each service worker possesses the
necessary skills to perform the specific services required to meet the needs of
the beneficiary he/she is to serve.
3. Staff is required to attend orientation
training prior to allowing the employee to deliver any Living Choices Assisted
Living Waiver service(s). This orientation shall include, but not be limited
to, a:
a. Description of the purpose and
philosophy of the Living Choices Assisted Living Waiver Program;
b. Discussion and distribution of the
provider agency's written code of ethics;
c. Discussion of activities which shall and
shall not be performed by the employee;
d. Discussion, including instructions,
regarding Living Choices Assisted Living Waiver record keeping
requirements;
e. Discussion of the
importance of the Plan of Care;
f.
Discussion of the agency's procedure for reporting changes in the beneficiary's
condition;
g. Discussion, including
potential legal ramifications, of the beneficiary's right to
confidentiality.
C.
Code of Ethics
The Provider agrees to develop, distribute and enforce a
written code of ethics with each employee providing services to a Living
Choices Assisted Living Waiver beneficiary that shall include, but not be
limited to, the following:
1. No
consumption of the beneficiary's food or drink;
2. No use of the beneficiary's telephone for
personal calls;
3. No discussion of
one's personal problems, religious or political beliefs with the
beneficiary;
4. No acceptance of
gifts or tips from the beneficiary or their caregiver;
5. No friends or relatives of the employee or
unauthorized individuals are to accompany the employee to the beneficiary's
assisted living facility apartment unit;
6. No consumption of alcoholic beverages or
use of non-prescribed drugs prior to or during service delivery nor in the
beneficiary's assisted living facility apartment unit;
7. No smoking in the beneficiary's assisted
living facility apartment unit;
8.
No solicitation of money or goods from the beneficiary;
9. No breach of the beneficiary's privacy or
confidentiality of records. I
D. Home and Community Based Services (HCBS)
Settings
All Level II Assisted Living Facilities licensed by the OLTC
and participating in the Arkansas Medicaid waiver must meet the following Home
and Community Based Services (HCBS) Settings regulations as established by CMS.
The federal regulations for the new rule is
42 CFR 441.301(c)
(4)-(5). Facilities who enroll in the waiver
on or after the date of this policy change must meet these HCBS settings
requirements prior to certification. Those facilities already enrolled in the
waiver before this policy change must comply with the HCBS settings
requirements under the timeframe established by the HCBS settings transition
plan.
Settings that are HCBS must be integrated in and support full
access of beneficiaries receiving Medicaid HCBS to the greater community,
including opportunities to seek employment and work in competitive integrated
settings, engage in community life, control personal resources, and receive
services in the community, to the same degree of access as beneficiaries not
receiving Medicaid HCBS.
HCBS settings must have the following characteristics:
1. Chosen by the individual from among
setting options including non-disability specific settings (as well as an
independent setting) and an option for a private unit in a residential setting.
a. Choice must be identified/included in the
person-centered service plan.
b.
Choice must be based on the individual's needs, preferences, and, for
residential settings, resources available for room and board.
2. Ensures an individual's rights
of privacy, dignity and respect, and freedom from coercion and
restraint.
3. Optimizes, but does
not regiment, individual initiative, autonomy and independence in making life
choices, including but not limited to, daily activities, physical environment
and with whom to interact.
4.
Facilitates individual choice regarding services and supports and who provides
them.
5. In a provider-owned or
controlled residential setting (e.g., Assisted Living Facilities), in addition
to the qualities specified above, the following additional conditions must be
met:
a. The unit or dwelling is a specific
physical place that can be owned, rented or occupied under a legally
enforceable agreement by the individual receiving services, and the individual
has, at a minimum, the same responsibilities and protections from eviction that
tenants have under the landlord/tenant law of the State, county, city, or other
designated entity. For settings in which landlord tenant laws do not apply, the
State must ensure that a lease, residency agreement or other form of written
agreement will be in place for each HCBS participant, and that the document
provides protections that address eviction processes and appeals comparable to
those provided under the jurisdiction's landlord tenant law.
b. Each individual has privacy in their
sleeping or living unit:
i. Units have
entrance doors lockable by the individual, with only appropriate staff having
keys to doors,
ii. Beneficiaries
sharing units have a choice of roommates in that setting,
iii. Beneficiaries have the freedom to
furnish and decorate their sleeping or living units within the lease or other
agreement.
c.
Beneficiaries have the freedom and support to control their own schedules and
activities, and have access to food at any time.
d. Beneficiaries are able to have visitors of
their choosing at any time.
e. The
setting is physically accessible to the individual.
f. Any modification of the additional
conditions specified in items a through d above must be supported by a specific
assessed need and justified in the person-centered service plan. The following
requirements must be documented in the person-centered service plan:
i. Identify a specific and individualized
assessed need.
ii. Document the
positive interventions and supports used prior to any modifications to the
person-centered service plan,
iii.
Document less intrusive methods of meeting the need that have been tried but
did not work,
iv. Include a clear
description of the condition that is directly proportionate to the specific
assessed need,
v. Include regular
collection and review of data to measure the ongoing effectiveness of the
modification,
vi. Include
established time limits for periodic reviews to determine if the modification
is still necessary or can be terminated,
vii.
Include the informed consent of the individual.
