12 Va. Admin. Code § 30-122-450 - Peer support service
A.
Service description. Peer mentor supports provide information, resources,
guidance, and support from an experienced, trained peer mentor to an individual
who is a waiver recipient. This service is delivered to waiver recipients by
other individuals with developmental disabilities who are or have been service
recipients, have shared experiences with the individual, and provide support
and guidance to him. The service is designed to foster connections and
relationships that build individual resilience. Peer mentor supports encourage
individuals with developmental disabilities to share their successful
strategies and experiences in navigating a broad range of community resources
beyond those offered through the waiver with waiver participants so that the
waiver participant is better able to advocate for and make a plan to achieve
integrated opportunities and experiences in living, working, socializing, and
staying healthy and safe in his own life, as well as to overcome personal
barriers which are inhibiting him from being more independent. Peer mentoring
is intended to assist with empowering the individual receiving the service.
This service is delivered based on the support needs of the individual as
outlined in his person-centered plan. This service shall require the use of a
peer support service administrative provider enrolled with DMAS that shall be
responsible for directly coordinating the service and directly billing DMAS for
reimbursement. This service is designed to be short-term and periodic in
nature.
B. Criteria and allowable
activities. Allowable activities may include the following for the individual
as documented in the individual's plan for supports:
1. The administering agency facilitates peer
to peer "matches" and follows up to ensure the matched relationship meets the
individual's expectations;
2. The
peer mentor has face-to-face contact with the individual to discuss the
individual's specific interests or desired outcomes related to realizing
greater independence and the barriers to achieving them;
3. The peer mentor explains community
services and programs and suggests strategies to the individual to achieve the
individual's desired outcomes, particularly related to living more
independently, engaging in paid employment, and expanding social opportunities
in order to reduce the need for supports from family members or paid
staff;
4. The peer mentor provides
information from his experiences to help the individual in problem solving,
decision making, developing supportive community relationships, and exploring
specific community resources that promote increased independence and community
integration; or
5. The peer mentor
assists the individual in developing a personal plan for accessing the
identified integrated community activities, supports, services, or
resources.
C. Service
units and limitations.
1. Peer mentor
supports is expected to be a short, periodically intermittent, intense service
associated with a specific outcome. Peer mentor supports may be authorized for
up to six consecutive months, and the cumulative total across that timeframe
may be no more than 60 hours in a plan year.
2. The peer mentor shall not supplant,
replace, or duplicate activities that are required to be provided by the
support coordinator. Prior to accessing funding for this waiver service, all
other available and appropriate funding sources shall be explored and
exhausted.
3. Peer mentors cannot
mentor their own family members.
4.
Peer mentors shall be at least 21 years of age and may provide these supports
only to individuals 16 years of age and older.
5. Individuals who receive supports through
DD Waiver or other waivers may be peer mentors.
D. Provider qualifications and requirements.
1. The administering agency shall be a DBHDS
licensed provider of DD Waiver services, employment service organization, or
center for independent living. The administering agency shall serve as the
enrolled provider and maintain the documentation of the peer mentor's
qualifications, criminal background and Child Protective Registry (if service
recipient is younger than 18 years of age) checks, and other required
documentation.
2. Peer mentor
supports shall be provided by an individual with a developmental disability who
has lived independently in the community for at least one year and is or has
been a recipient of services, including to publicly-funded housing, Medicaid
waiver services, work incentives, and supported employment.
3. The peer mentor shall have completed
DBHDS's DD Peer Mentor training curriculum and passed the accompanying
test.
4. The peer mentor supports
administering agency shall have a signed provider participation agreement with
DMAS.
E. Documentation
requirements for service providers.
1.
Providers shall include in each individual's record:
a. A copy of the completed, standard,
age-appropriate assessment form as described in 12VAC30-122-200.
b. The provider's plan for supports per
requirements detailed in 12VAC30-122-120.
c. Documentation which shall confirm the
individual's amount of time in services, a log of contacts, and information
regarding the type of supports delivered to the individual.
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 individual's record shall be submitted to the
support coordinator quarterly, during any quarters in which the service was
provided, with the plan for supports, if modified. This written review shall
list the dates and nature of contacts and a statement about the individual's
satisfaction with the service.
f.
All correspondence to the individual and the individual's family/caregiver, as
appropriate, the support coordinator, DMAS, and DBHDS.
g. Written documentation of all contacts with
family/caregiver, physicians, formal and informal service providers, and all
professionals regarding the individual.
h. Documentation of the peer mentor's
qualifications, as well as criminal background and Child Protective Registry
(if service recipient is younger than 18 years of age) checks.
2. Administering agency
documentation shall support all claims submitted for DMAS reimbursement. Claims
that are not supported by appropriate documentation shall be subject to
recovery by DMAS as a result of utilization reviews and audits.
Notes
Statutory Authority: § 32.1-325 of the Code of Virginia; 42 USC § 1396 et seq.
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