12 Va. Admin. Code § 30-122-310 - Community coaching service
A.
Service description. Community coaching is a service designed for individuals
who need one-to-one support in a variety of community settings in order to
build a specific skill or set of skills to address particular barriers that
prevent individuals from participating in activities of community engagement.
In addition to skill building, this service includes routine and safety
supports. Community coaching service shall be covered in the FIS, CL, and BI
waivers.
B. Criteria and allowable
activities. Community coaching service shall be provided to individuals who
require one-to-one support to address identified barriers in their plans for
supports that prevent them from participating in the community engagement
service. Community coaching activities shall be documented in the plan for
supports and be sensitive to the individual's age, abilities, and personal
preferences. Allowable activities shall include, as may be appropriate for the
individual as documented in his plan for supports:
1. One-on-one skill building and coaching to
facilitate participation in community activities and opportunities such as:
a. Activities and public events in the
community;
b. Community education,
activities, and events; and
c. Use
of public transportation if available and accessible.
2. Skill building and support in positive
behavior, relationship building, and social skills.
3. Routine supports with the individual's
self-management, eating, and personal care needs in the community.
4. Assuring the individual's safety through
one-to-one supervision in a variety of community settings.
5. Monitoring the individual's health and
physical condition and providing supports with medication and other medical
needs.
6. Providing routine
supports and safety supports with transportation to and from community
locations and resources.
C. Service units and limitations.
1. The unit of service shall be one
hour.
2. The community coaching
service, alone or in combination with the community engagement service, group
day service, workplace assistance service, or supported employment service
shall not exceed 66 hours per week.
3. This service shall be provided at a ratio
of one staff to one individual. This service shall not be provided within a
group setting. The service may be provided in the community in conjunction with
other Medicaid services delivered in a group of individuals for the purpose of
addressing socialization needs when supported by the plan for supports. Group
participation will be permitted on a limited basis.
D. Provider qualifications and requirements.
2. Providers shall be licensed by DBHDS as
providers of the non-center-based day support service.
3. Providers shall have a current, signed
provider participation agreement with DMAS to provide this service. The
provider designated in the participation agreement shall directly provide the
service and bill DMAS for reimbursement.
4. Providers shall ensure that staff who
provide the community coaching service meet provider training and competency
requirements as specified in 12VAC30-122-180.
5. The DSP providing community coaching
service shall not be an immediate family member of an individual receiving the
community coaching service. For an individual receiving the sponsored
residential service, the DSP providing the community coaching service shall not
be a member of the sponsored family residing in the sponsored residential
home.
E. Service
documentation and requirements.
1. Providers
shall include signed and dated documentation of the following in each
individual's record:
a. A copy of the
completed, standard, age-appropriate assessment form as detailed in
12VAC30-122-200.
b. The provider's
plan for supports per requirements detailed in 12VAC30-122-120.
c. Documentation as detailed in
12VAC30-122-120. Data shall be collected as described in the ISP, analyzed to
determine if the strategies are effective, summarized, and then clearly
documented in the progress notes or supports checklist.
d. Documentation to support units of service
delivered, and the documentation shall correspond with billing. Providers shall
maintain separate documentation for each type of service rendered for an
individual.
e. A written review
supported by documentation in the individuals' record, which is submitted to
the support coordinator at least quarterly with the plan for supports, if
modified. For the annual review and every time supporting documentation is
updated, the supporting documentation shall be reviewed with the individual or
family/caregiver, as appropriate, and such review shall be documented.
f. An attendance log or similar
document maintained by the provider that indicates the date, type of service
rendered, and the number of hours and units provided, including specific
timeframe.
g. All correspondence to
the individual and the individual's family/caregiver, as appropriate, the
support coordinator, DMAS, and DBHDS.
h. Written documentation of all contacts with
the individual's family/caregiver, physicians, providers, and all professionals
regarding the individual.
2. Supervision of DSPs shall be provided
consistent with the requirements in 12VAC30-122-120 by a supervisor meeting the
requirements of
12VAC35-105-590.
Providers shall make available for inspection documentation of supervision, and
this documentation shall be completed and signed by the staff person designated
to perform the supervision and oversight. This documentation shall include, at
a minimum, the following:
(i) date of contact
or observation;
(ii) person
contacted or observed;
(iii) a
summary about the direct support professional's performance and service
delivery; and
(iv) any action
planned or taken to correct problems identified during supervision and
oversight.
3. Provider
documentation shall support all claims submitted for DMAS reimbursement. Claims
for payment that are not supported by supporting documentation shall be subject
to recovery by DMAS or its designee as a result of utilization reviews or
audits.
Notes
Statutory Authority: § 32.1-325 of the Code of Virginia; 42 USC § 1396 et seq.
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