Mont. Admin. R. 37.40.1005 - AGENCY-BASED AND SELF-DIRECTED COMMUNITY FIRST CHOICE SERVICES: PERSON-CENTERED PLAN REQUIREMENTS
(1) In order to
receive Community First Choice Services (CFCS), the member must be capable of
making choices about activities of daily living and instrumental activities of
daily living. The member must be able to understand the impact of these choices
and assume responsibility for the choices. If the member is unable to meet
these criteria, the member may have someone assist them in decision making and
directing their activities. The CFCS person-centered planning process includes
multiple steps to protect a member's health and safety while ensuring that
member choice and control are an integral component of service delivery. Prior
to delivering CFCS, the following person-centered planning requirements must be
met:
(a) a licensed contract nurse must
complete a functional assessment and service profile;
(b) a plan facilitator must complete the
person-centered plan; and
(c) a
nurse supervisor or program oversight staff must complete the service
plan.
(2) The
Person-Centered Planning requirements in (1) may be delayed in the
circumstances outlined in (7).
(3)
The quality improvement organization will define the member's medical and
functional needs in a functional assessment and service profile. The functional
assessment and service profile must meet the following criteria:
(a) a licensed contract nurse will develop
and review the member's functional assessment and service profile initially and
will renew it at least annually; and
(b) the service profile will establish the
maximum authorization for CFCS in a two-week time period.
(4) The member and plan facilitator must meet
to complete a person-centered plan that identifies, in writing, member-specific
goals and objectives for the delivery of CFCS. The plan facilitator must ensure
the person-centered plan is completed prior to service and renewed at least
annually. The person-centered plan will be based on the member's functional
assessment and service profile as provided by the quality improvement
organization.
(a) In agency-based CFCS, the
CFCS provider agency nurse supervisor must participate in the initial and
annual person-centered planning visit.
(b) In self-directed CFCS, the CFCS provider
agency oversight staff must participate in the initial and annual
person-centered planning visit.
(5) The service plan will identify the type
and amount of CFCS and will govern the delivery of service. The service plan
must meet the following criteria:
(a) in
agency-based CFCS, the agency nurse supervisor must approve the service plan
initially, and must recertify the service plan every six months;
(b) in self-directed CFCS, the provider
agency oversight staff must approve the service initially, and must recertify
the service plan every six months;
(c) the plan must address the member's
medical and functional need for service; and
(d) the plan must not exceed the service
profile authorization for hours delivered in a two-week time period.
(6) A member will not receive CFCS
beyond the service profile authorization unless one of two conditions is met:
(a) The provider agency implements a
temporary service plan as outlined in (7).
(i) in agency-based CFCS, the provider agency
nurse supervisor must sign the temporary service plan and prescribe in writing
the member's needs for the increase in services.
(ii) in self-directed CFCS, the provider
agency oversight staff must sign the temporary service plan and prescribe in
writing the member's needs for the increase in services.
(b) The provider agency approves medical
escort service during the time period. The provider agency must provide
documentation to ensure the escort was provided according to program
parameters.
(7) If a
member is at high risk for institutionalization or in need of temporary CFCS,
the provider agency may implement services immediately that include activities
of daily living without the functional assessment, service profile, and
person-centered plan in place. In this case the provider agency must implement
a temporary service plan. The provider agency must use a department-approved
form to document the temporary service plan. The temporary service plan must
prescribe in writing the member's medical and functional need for service. The
provider must refer the member to the quality improvement organization for a
functional assessment by the 28th day of the temporary service plan or they
must discharge the member.
(a) In
self-directed CFCS, the health care professional must complete the health care
professional authorization form prior to the delivery of services and the
provider agency oversight staff must complete and sign the service plan prior
to the delivery of services.
(b) In
agency-based CFCS, the provider agency nurse supervisor must complete and sign
the temporary service plan prior to the delivery of services.
(8) The member must agree to
accept the provision of CFCS as specified in the person-centered service
plan.
(9) The CFCS provider must
have a written complaint process. The member may receive a copy upon request.
The provider must adhere to the process for any member complaints related to
the person-centered planning and service-delivery process.
(10) The delivery of agency-based CFCS must
be supervised by a licensed agency nurse. Supervision includes oversight of the
training and orientation of direct-care workers.
Notes
53-2-201, MCA IMP: 53-2-201, 53-6-113, MCA;
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