12 Va. Admin. Code § 30-122-390 - Group home residential service
A. Service description. Group home
residential service shall consist of skill-building, routine supports, general
supports, and safety supports that are provided to enable an individual to
acquire, retain, or improve skills necessary to successfully live in the
community. This service shall be provided to individuals who are living in (i)
a group home or (ii) the home of an adult foster care provider. Group home
residential service shall be a tiered service for reimbursement purposes (as
described in 12VAC30-122-210 ) based on the individual's assigned level and
tier and licensed bed capacity of the home. The number of licensed beds in a
setting reimbursed for group home residential services shall not exceed six.
Group home settings larger than six licensed beds that became DD Waiver
providers prior to March 31, 2021, may continue to operate and receive Medicaid
reimbursement. If a group home larger than six licensed beds changes ownership,
the group home will be considered a new setting and the licensed bed capacity
limit of six beds shall apply for Medicaid reimbursement purposes. Group home
residential service shall be provided to the individual continuously up to 24
hours per day performed by paid staff that shall be physically present. This
service may be provided either individually or simultaneously to more than one
individual living in that home, depending on the required support. Group home
residential service shall be covered in the CL waiver.
B. Criteria and allowable activities.
1. The allowable activities shall include, as
may be appropriate for the individual as documented in his plan for supports:
a. Skill-building and providing routine
supports related to ADLs and IADLs;
b. Skill-building and providing routine
supports and safety supports related to the use of community resources, such as
transportation, shopping, restaurant dining, and participating in social and
recreational activities;
c.
Supporting the individual in replacing challenging behaviors with positive,
accepted behavior for home and community environments;
d. Monitoring the individual's health and
physical condition and providing supports with medication and other medical
needs;
e. Providing routine
supports and safety supports with transportation to and from community
locations and resources;
f.
Providing general supports, as needed; and
g. Providing safety supports to ensure the
individual's health and safety.
2. Group home residential service shall
include a skill-building component along with the provision of supports as may
be needed by the individuals who are participating.
C. Service units and limits.
1. The unit of service shall be a day.
Providers may bill the unit of service if any portion of the plan for supports
is provided during that day.
2.
Group home residential service shall be authorized for Medicaid reimbursement
only when the individual in the CL waiver requires this service and the service
is set out in the plan for supports.
3. Group home residential service settings
shall comply with the HCBS setting requirements per 42 CFR 441.301. In these
settings, lease or residency agreements shall comply with and support
individual choice of service and setting.
D. Provider qualifications and requirements.
1. Providers shall meet all of the
requirements set forth in 12VAC30-122-110 through 12VAC30-122-140.
2. The provider of group home residential
service for adults who are 18 years of age or older shall be licensed by DBHDS
as a provider of the group home residential service or a provider approved by
the local department of social services as an adult foster care provider
(12VAC35-105-20 ).
Providers of the group home residential service for children (up to the child's
18th birthday) shall be licensed by DBHDS as children's residential
providers.
3. All providers of
group home residential service shall have a current provider participation
agreement with DMAS. Providers designated on this agreement shall render the
group home residential service and shall bill DMAS directly for
reimbursement.
4. Providers shall
ensure that staff providing the group home residential service meet provider
training and competency requirements specified in 12VAC30-122-180.
5. 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.
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 specified 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, 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. Providers' claims that are not adequately supported by
corresponding documentation may be subject to recovery of expenditures
made.
e. A written review supported
by documentation in the individuals' record will be 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. All correspondence to the
individual and the individual's family/caregiver, as appropriate, the support
coordinator, DMAS, and DBHDS.
g.
Written documentation of contacts made with the individual's family/caregiver,
physicians, providers, and all professionals concerning the
individual.
2. 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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