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Draft 6/23/15.  Is done when there is a compelling reason for change to: ◦ Adhere to state statute (IC) ◦ Adhere to federal requirements (CFR)  Is a.

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Presentation on theme: "Draft 6/23/15.  Is done when there is a compelling reason for change to: ◦ Adhere to state statute (IC) ◦ Adhere to federal requirements (CFR)  Is a."— Presentation transcript:

1 draft 6/23/15

2  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

3  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)

4  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

5  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

6  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

7  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 participant’s desired outcomes ◦ Choices based upon optimizing community engagement ◦ Participant choice on when and how services will be provided

8  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

9  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

10  All providers must provide services with professionalism and with respect to the participant’s 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

11  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:  Provider’s Board of Directors  Relative of the Provider’s Board of Directors  Provider’s staff or employees  Relative of Provider’s Administrative staff  No case manager may provide another service  No case manager shall allow an uncertified person to provide case management service

12  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

13  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

14  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

15  Provider must give at least 30 days written notice to: ◦ The participant or legal guardian if applicable ◦ The participant’s Case Manager ◦ The Division of Aging  ISDH licensed providers must follow ISDH’s rules  The Case Manager must coordinate the service transfer Continued next slide

16  Provider must continue to deliver services until: new provider starts service participant terminate provider DA authorized termination of provider’s 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

17  The DA may terminate a participant’s 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

18  Comments:  The “final” draft of 455 IAC2 will be posted on the Division of Aging’s website along with public hearings on proposed changes:   Comments may be sent to:   THANK YOU!

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