455 IAC 2 HCBS rule Preliminary changes draft 6/23/15 Promulgation of a revised rule Is done when there is a compelling reason for change to: Adhere to state statute (IC) Adhere to federal requirements (CFR) Is a long process which can last between 12-18 months Requires public input during the process
This is a preliminary presentation to gather input/answer questions before we submit a revision What providers are affected: A&D and TBI providers C.H.O.I.C.E. providers Title III A*-E Older Americans Act providers Social Service Block Grant Providers All services paid for with any of these funds including, but not limited to:
Home Health Agencies (HHA) Personal Service Agencies (PSA) Assisted Living settings (AL) Adult Family Care settings (AFC) Structured Family Care settings (SFC) *Includes Area Agencies on Aging (AAA) New & Revised Sections: Person-Centered Planning & service delivery Personal life style choices in settings Payment of Room & Board
Code of Ethics Conflict of Interest Legal Responsibility Financial Responsibility Family Caregivers Deaths no longer reportable to APS Provider Termination Participant Termination Legal Responsibilities Maintain the confidentiality of participant information as required by law including Health Insurance Portability and Accountability Act-HIPAA Maintain professional licenses as required
for specific service delivery Operate licensed services within the scope of practice Maintain liability insurance at minimum of $100,000 Financial Responsibility Maintain cash reserves or line-of-credit minimum of $35,000 to support operations while reimbursement is pending Maintain financial records in accordance with generally accepted accounting principles Assure financial records are audited and audit findings are submitted to DA upon
request Maintain separate accounts for funds managed for participants in AL, AFC, SFC Person-Centered Planning Participant involvement through needs assessment and person-directed care plan development. Service options determined by assessed need and provision in least restrictive setting Choices based upon optimizing participants desired outcomes Choices based upon optimizing community
engagement Participant choice on when and how services will be provided Personal Lifestyle Choices in settings Freedom to come and go whenever participant wishes Freedom to have guests at any time Freedom to lock door to own private space Freedom to choose to have a roommate or not Access to food at all times Freedom from restraints or restrictions not included in risk plan Privacy in living and sleeping space and be
able to decorate their new home as desired Payment of Room & Board For Assisted Living and Adult Family Care Settings Participant must always have Personal Needs Allowance excluded from Room & Board payment Monthly Room and Board payment of waiver participants must not exceed monthly SSI level, so Provider may not always receive SSI level of payment if it would result in loss of any of the personal needs allowance
Code of Ethics All providers must provide services with professionalism and with respect to the participants uniqueness and values Avoid any discrimination of any kind Allow participant to make informed choices Accurately represent service abilities Require staff to adhere to service standards Require staff to adhere to scope of practice Require staff to adhere to HIPAA Refrain from misleading marketing to or uninvited solicitation of potential participants
Conflict of Interest All providers must avoid conflict of interest or any appearance of conflict by assuring funds covered by this rule are not awarded to any entity that is owned or controlled by: Providers Board of Directors Relative of the Providers Board of Directors Providers staff or employees Relative of Providers Administrative staff No case manager may provide another service No case manager shall allow an uncertified person to provide case management service Paid Family Caregivers
Legally responsible individuals of participants under age 18 and spouses or legal guardians of a participant over age 18 shall not be an employed or contracted caregiver Non-legally responsible adults may be a paid caregivers through: Employment by a ISDH licensed Home Health or Personal Service agency operating within their scope of practice Working for the self-directed care program operating within their scope of practice Reports of Participants
Death Required to be reported to DA Incident Report website within 24 hours of knowledge No longer required to be reported to Adult Protective Services (APS) or Department of Child Services (DCS) UNLESS: Death is the result of suspected ABUSE or NEGLECT Provider Termination
DA may revoke approval of a provider when: Medicare or Medicaid or other FSSA entity has sanctioned or terminated provider ISDH has revoked license or provider has failed to renew license Provider failed to report to DA within 10 days on any above sanction or revocation Repeated or continued violations of this rule: 455 IAC2 Any violation that has endangered health or welfare of participant giving 60 days written notice to the provider along with administrative review rights Participant Service
Termination Provider must give at least 30 days written notice to: The participant or legal guardian if applicable The participants Case Manager The Division of Aging ISDH licensed providers must follow ISDHs rules The Case Manager must coordinate the service transfer Continued next slide
Participant Service Termination Provider must continue to deliver services until: new provider starts service participant terminate provider DA authorized termination of providers service Unsafe work environment: Provider may terminate services immediately Provider must contact: Police, Emergency Services, and APS/DCS if appropriate
File an Incident Report with DA Participant Program Termination The DA may terminate a participants waiver services if participant: Is placed in a Nursing Facility No longer resides in Indiana Poses a health and safety risk to themselves or others No longer meets A&D NFLOC or TBI ID/IID LOC Loses Medicaid eligibility Fails to abide by the terms of the waiver program Voluntarily withdraws from waiver services
Questions? Comments: The final draft of 455 IAC2 will be posted on the Division of Agings website along with public hearings on proposed changes: www.in.gov/fssa/da Comments may be sent to: [email protected] THANK YOU!
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