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MECKLENBURG COUNTYDepartment of Social Services

ADULT DAY CARE PROGRAM PROCEDURES MANUAL FOR CONTRACT SERVICE PROVIDERS

July 2018

Table of Contents

I. INTRODUCTION ...........................................................................PAGE 2

II. DEFINITIONS ...................................................................................PAGE 2

III. COUNTY EMPLOYEES ROLES AND RESPONSIBILITIES ...................PAGE 2- 3

IV. GOALS AND OBJECTIVES ..............................................................PAGE 3-4

V. SERVICE PROVISION ....................................................................PAGE 4-8A. SERVICE REQUESTB. INQUIRY LISTC. ELIGIBILITYD. PRIORITY GROUPE. REFERRALS F. CERTIFICATION G. CHANGE IN SERVICE H. PROGRAM RECORDS

VI. RESPONSIBILITIES ......................................................................PAGE 8-16A. NC DIVISION OF AGING AND ADULT SERVICESB. DEPARTMENT OF SOCIAL SERVICESC. SERVICE PROVIDERD. CONSULTATION/MONITORINGE. CORRECTIVE ACTIONSF. NEGATIVE ACTIONS

VII. SERVICE PROVIDER AGREEMENT POLICIES/PROCEDURES .........PAGE 16-19A. TERMB. REIMBURSEMENTC. CONSUMER CONTRIBUTIONSD. DONATIONSE. PERFORMANCE STANDARDS

APPENDIX: FORMS

ADULT DAY CARE PROGRAM PROCEDURES MANUAL FOR CONTRACT SERVICE PROVIDERSPage 1

I. INTRODUCTION

The Mecklenburg County Department of Social Services, Adult Day Care Program Procedures Manual for Contract Service Providers is designed to provide operational guidelines to the certified Adult Day Care Programs who serve DSS customers through contractual agreement with the Mecklenburg County Department of Social Services (DSS). This information is binding and can be changed or amended only upon a supplemental written document distributed to each contracted Service Provider. The purpose is to work together to provide quality services to the elderly and adults with disabilities of Mecklenburg County who choose to participate in an organized day program which encourages and supports personal independence as well as social, physical and emotional well-being.

II. DEFINITIONS OF TERMS

A. Adult Day Care Program: The provision of group care and supervision in a place other than the usual place of abode on a less than 24-hour basis to adults who may be physically or mentally disabled. This term is used to refer to adult day care programs, adult day health programs, and adult day care and combined adult day health programs (i.e. combination programs).

B. DSS-5027: North Carolina Division of Social Services Information System Customer Entry Form is the application form the DSS Social Worker completes on customers who request services and the form the DSS Social Worker will use to notify the Service Providers as well as the Adult Day Services Coordinator regarding customers’ authorization for service; revisions to service and/or termination from service.

C. Enrolled: The number of days the customer is authorized on the DSS-5027 to attend the Adult Day Care Program.

1. Full-Time Enrollment: Customer enrolled for 5 days a week during each week.

2. Part-Time Enrollment: Customer enrolled for 4 or less days a week during each week.

D. Absent: The number of day(s) out of enrolled days, the customer does not attend the Adult Day Care Program.

III. COUNTY EMPLOYEES ROLES AND RESPONSIBILITIES

EMPLOYEES RESPONSIBLE FOR MONITORING OR REVIEWING THE OPERATIONS OF THE ADULT DAY CARE PROGRAM.

A. Project Manager: Responsible point of contact person for DSS with subject matter expertise and authority to make decisions. Liaison person between the Service Provider and DSS. The Project Manager advises the Contract Administrator regarding issues that need to be addressed in the contract.


B. Social Worker: Responsible for conducting assessments and reassessments; developing, implementing and revising the DSS-5027; observing DSS customers in the Adult Day Care Program and evaluating DSS customers records/attendance to ensure services are being performed as authorized, appropriate for customer’s level of care and meet requirement for customer’s continued eligibility for services. DSS Social worker is responsible for requesting consumer contributions from DSS customers.

C. Adult Day Services Coordinator: Responsible for ensuring that the Adult Day Care Program Service Providers meet and maintain certification by the North Carolina Division of Aging and Adult Services by conducting on-site reviews of the operations on a regular basis to ensure compliance. Review attendance rosters of DSS customers approved for enrollment and reconcile with the monthly invoices to ensure accurate payment is authorized and the use of funds are adequately utilized for customers in attendance. The attendance rosters are reconciled monthly to support the payment of the invoice.

D. Adult Day Health Specialist: Responsible for monitoring Adult Day Care Program Service Providers to ensure compliance with standards for certification, including reviewing timesheets of the program’s Home Care Coordinator and Nurses to ensure an RN or LPN is located on the facility for at least four hours each day the program is open for service. The Adult Day Health Specialist works closely with the Adult Day Services Coordinator.

E. Contract Administrator: Responsible for the County contract, however, other DSS personnel assigned to the contract will also ensure compliance of the contract by reporting any non-compliance issues to the Contract Administrator for enforcement. The Contract Administrator will conduct an on-site visit at least annually to ensure contracted services are in place. Areas of responsibility are noted in the contract for each of the staff assigned to the contract. With each staff, there is an area of expertise that compliments the other.

IV. GOALS AND OBJECTIVES:

Adult Day Care Programs assist individuals and caregivers in obtaining and maintaining the following goals and objectives established by the North Carolina Division of Aging and Adult Services:

A. Economic Self-support: Increasing Caretaker EmployabilityAble-bodied persons who are responsible for providing the care required by a dependent adult can seek and accept employment if provisions can be made for care during working hours.

B. Personal Self-sufficiency: Providing A Means Of Overcoming Social Isolation And Its Motivational Effects1. Creating contact among persons who are often socially isolated, aids in overcoming the

loss of self-esteem and self-respect that comes with isolation and promotes maintenance of good physical and mental health.


2. Providing for developmentally disabled participants, training in skills needed in everyday living which will help them reach their maximum level of independent functioning.

3. Preventing or Remedying Abuse, Neglect or Exploitation: Aiding in achievement of the goal of “Personal Self-sufficiency”.

4. Day activity programs bring aging and disabled persons out of social isolation and help to promote a sense of self-worth and interest in daily life so that they are less likely to neglect themselves. Thus, progress in becoming self-sufficient prevents or remedies self-neglect.

5. Reducing the burden of an overwhelmed caretaker. A caretaker who is or would be overwhelmed by the responsibility of providing full-time care of a dependent adult is often prone to frustration, aggression, or burn-out. Such aggression, in turn, is often directed at the dependent adult, or the burnt-out caretaker may be unable to provide the necessary care. Partial relief of responsibility for providing care is frequently sufficient to overcome these causes of abuse and neglect.

C. Avoiding Inappropriate Institutional Care: Allowing A Dependent Adult’s Family To Attain Or Maintain The Goal Of “Economic Self-Support”1. Providing care for a dependent adult during working hours is often necessary for able-

bodied members of that person’s family to become employable or to remain employable. The income gained from such employment may determine whether or not such a person’s family is able to afford to maintain him or her at home.

2. Providing services to persons whose needs are not actually sufficient to require institutionalization if there is a community-based care alternative.

V. SERVICE PROVISION

A. REQUEST FOR SERVICE Individuals may either call Mecklenburg County DSS number (704-432-1111) or appear in person to request services. A DSS Social Worker will be assigned to determine eligibility and complete and an in home assessment to determine what assistance is needed. If approved, the customer’s case is assigned to the Adult Care Center of the customer or caregiver’s choice.

B. INQUIRY LISTWhen funding for the Adult Day Care Program is not available at the time of request, the social worker will place the individual’s name on the Mecklenburg County Adult Day Care Program “Inquiry List” if appropriate. Other services including 330 (case management) will be offered. Once funding is available, a DSS Social Worker will be assigned to determine eligibility and to complete an in home assessment to identify assistance needed by the customer/caregiver.

C. ELIGIBILITY


An individual must reside in Mecklenburg County and be 60 years of age or older or a person 18 years of age or older with a medically documented disability in need of services to enable them to remain in or return to their own homes. For HCCBG funded services an individual must be aged 60 or over and must be unable to perform at least two activities of daily living (ADLs) without substantial human assistance, including verbal reminding, physical cueing or supervision OR due to a cognitive or other mental impairment, requires substantial supervision because the individual behaves in a manner that poses a serious health or safety hazard to the individual or another individual. AND require one of the following during hours of attendance at the day health program: monitoring of a medical condition or provision of assistance with or supervision of activities with daily living or administration of medication, special feedings or provision of other treatment or services related to health care needs.

If a client does not have 2 ADL impairments, the social worker will send the client’s physician a medical form to determine if the client needs substantial supervision.

See DAAS Administrative Letter for details. http://www.ncdhhs.gov/aging/admltrs/2014/DAAS-14-06.pdf

D. PRIORITY GROUP Once an individual is determined to be eligible for services, the individual shall be served in accordance with “Priority for Receipt of Block Grant Services” of the Home and Community Care Block Grant Procedures Manual for Community Service Providers as determined by DSS:

1. Older adults for whom the need for Adult Protective Services has been substantiated by the local DSS and the service is needed as part of the adult protective service plan.

2. Older adults who are at risk of abuse, neglect, and/or exploitation.

3. Older adults with extensive impairments in activities of daily living (ADL's), or instrumental activities of daily living (IADL's), who are at risk of placement or substitute care. "ADL's" include: eating, dressing, bathing, toileting, bowel and bladder control, transfers, ambulation and communication (ability to express needs to others e.g. speech, written word, signing, gestures, and communication devices). "IADL's" include: meal preparation, medication intake, cleaning, money management, phone use, laundering, reading, writing, shopping and going to necessary activities.

4. Older adults with extensive ADL or IADL impairments.

5. Older adults with less extensive (1-2) ADL or IADL impairments.

6. Well Older Adults

E. REFERRALS Potential caregivers and customers will be given a list of the ADHC centers in Mecklenburg. They will be encouraged to visit the centers, utilize free trial days and if transportation is needed, contact transportation providers such as STS and ADHC centers to find out if


http://www.ncdhhs.gov/aging/manual/hccbg/hccbg.htm


http://www.ncdhhs.gov/aging/manual/hccbg/bgsect2.pdf

http://www.ncdhhs.gov/aging/admltrs/2014/DAAS-14-06.pdf

transportation is available. The caregiver or client should also get a TB test from their physician. DSS will notify the Service Provider when referring a new prospective customer for service by completing a To Do in the Core system. Prospective customers will be referred by DSS to the Service Provider based on their choice of provider. Once a caregiver/customer picks an ADHC, the social worker will complete the ADHC service plan in Core and notify the ADHC by way of a To Do. The ADHC will assess the client and notify the DSS social worker in the Notes section of Core via a To Do whether they feel they can accept the client and care for them. The DSS social worker will then complete the 5027 in Core and notify the ADHC and the DSS Day Care Coordinator of the 5027 by completing a To Do in Core. The DSS-5027 and the To Do to the ADHC will be completed in Core within five (5) days of a customer being authorized for service. The Service Provider must report action taken on the referral to the DSS Social Worker within 7 calendar days of receipt to ensure services start within 10 calendar days of the DSS Social Worker authorizing service on the DSS-5027.

1. Referral AcceptedIf the Service Provider accepts the DSS referral for service, the DSS Social Worker, the Service Provider, and the prospective customer and/or caregiver will jointly consider the number of days the prospective customer will attend the program.

2. Referral Not-Accepted – Applicant Does Not Meet Day Care CriteriaIf the Service Provider cannot accept the DSS referral for service due to the prospective customer not meeting day care enrollment criteria and no other contracted Service Provider can meet the needs of the prospective customer, the service will be denied to the prospective customer and the DSS Social Worker will seek out other resources for the customer.

3. Referral Not-Accepted – Day Care Cannot Meet Applicant NeedsIf the Service Provider cannot accept the DSS referral for service due to the Service Provider’s inability to meet the needs of the prospective customer, the service will not be denied to the prospective customer. DSS will forward the referral to another contracted Service Provider of the customer’s choosing for consideration and the Service Provider who initially refused the referral will not receive a replacement referral from the inquiry list.

F. Certification for Service The DSS Social Worker will notify the customer/caregiver, Service Provider as well as the Adult Day Services Coordinator by way of form DSS-5027 of the number of days the customer is authorized to attend the Adult Day Care Program and the certification period for which services are authorized.

The Service Provider must inform the DSS Social Worker of the customer’s start and end date of service prior to the customer attending the program. Service Provider must perform a comprehensive assessment and written services plan for each individual to meet the North Carolina Adult Day Care and Day Health Services Standards for Certification.


Adult Day Care Program customers will have services begin within 10 calendar days of the DSS Social Worker authorizing services on the DSS-5027.

G. CHANGE IN SERVICEDSS will work with the Service Provider to determine if the enrollment status of the customer is appropriate based on actual days of attendance, change in health status and/or family dynamics. The enrollment status can be adjusted to meet the needs of the customer and/or caregiver and to maximize service delivery; however, any change in service must be authorized by the DSS Social Worker and documented on the DSS-5027 prior to the change occurring.

1. Change in Health Status or Level of CareService Provider must notify the DSS Social Worker when the customer is hospitalized, placed into rehabilitation/nursing home facility and/or when there is a change in the level of care. DSS strongly encourages the Service Provider to contact the DSS Social Worker if there are any concerns regarding the customer’s well-being. This can be documented in the Notes section of Core and by completing a To Do for the social worker.

a. If the level of care increases from Adult Day Care to Adult Day Health, the day care will only be paid at that level after the DSS Social Worker is notified and has completed the required paperwork authorizing the change on the DSS-5027. The DSS Social Worker will complete the authorization within three (3) business days.

b. If it is determined that regular or modified participation will resume, the enrollment will be kept active and payment will continue, for a period based on the availability of funding and social work assessment. If participation by the customer has not resumed within the time frame specified in the assessment, payment will cease and enrollment may be terminated.

c. If it is determined that regular or modified participation will not resume, enrollment will be terminated immediately and payment will cease.

d. If the Service Provider identifies a need to either increase or decrease days, the Service Provider must notify the DSS Social Worker who will evaluate and discuss the need with the customer/caregiver. An increase in services is based upon availability of funding.

2. Frequent AbsencesService Provider must notify the DSS Social Worker when the customer is frequently absent from the program. Consecutive absence will be based on the customer’s enrollment status.

a. A full time customer is absent for five (5) consecutive days.b. A part time customer is absent for four (4) or less consecutive days.


If the customer is absent for 10 consecutive scheduled days or less and would like to resume regular or modified participation, the enrollment will be kept active and payment will continue for a period based on the availability of funding and social work assessment.

If customer is absent for 10 consecutive scheduled days and does not want to resume regular or modified participation, after the 10th day, the Service Provider must inform the DSS Social Worker and stop billing for service. DSS will cease payment and the enrollment will be terminated immediately.

3. TerminationThe Service Provider and DSS must consult with one another prior to terminating a customer’s service.

a. A customer can be terminated immediately if the customer/caregiver request to end services, the customer dies, moves out of county or is placed into a facility and does not plan to return to the program. Payment will cease at the time of termination.

b. If the Service Provider terminates services, the Service Provider must inform the DSS Social Worker within 72 hours. The DSS Social Worker will complete a To Do in Core notifying the Adult Day Services Coordinator and Service Provider of the updated 5027.

c. If the DSS Social Worker terminates services, the DSS Social Worker will complete a To Do in Core notifying the Adult Day Services Coordinator and Service Provider of the updated 5027.

H. PROGRAM RECORDSMaintain all program records for a period of seven (7) years from the date of final payment for inspection by DSS, the North Carolina Division of Aging and Adult Services, the Division of Social Services or any of their duly authorized representatives.

VI. RESPONSIBILITIES

A. NORTH CAROLINA DIVISION OF AGING AND ADULT SERVICES 1. To develop standards and policies for the delivery of the Adult Day Care Program by

county departments of social services and day care providers; and to certify all adult day care programs as meeting adult day care standards based on the report and recommendation of the county DSS and the Adult Day Care Consultant in the state office.

2. To work with county DSS through the Adult Day Services Coordinator who serves as a liaison between DSS, the North Carolina Division of Aging and Adult Services and day care providers regarding the development of adult day care services, interpretation of standards for certification and related issues.


B. DEPARTMENT OF SOCIAL SERVICES1. To be responsible for all activities at the local level concerning program certification.

The provisions of 10A NCAC 06P .0402 (3) specify that the county carry out this responsibility through the Adult Day Services Coordinator of the county who is to “become familiar with all aspects of the program operation including administration, activities and services provided and customer and program records.”

2. To ensure the program operation of the Adult Day Care Program Service Provider meets the minimum state standards for certification and additional requirements of the federal funding sources as well as to ensure good service for our DSS customers.

C. SERVICE PROVIDER1. Adherence To Adult Day Care Program and Fiscal Requirements

Provide service to comply with all fiscal, eligibility and program requirements of the State of North Carolina Division of Aging and Adult Services as outlined in the Fiscal Manual, Volume VI Service Administration Manual and the Family Services Manual; the Home and Community Care Block Grant Procedures Manual for Community Service Providers; the Adult Home Services Certification Procedures Manual; and the Mecklenburg County Department of Social Services, Adult Day Care Program Procedures Manual for Contracted Service Providers.

2. Holiday and Hazardous Weather ScheduleProvide a "Holiday Schedule" to the Adult Day Services Coordinator identifying days the program will be closed on a County designated holiday. Notify the Adult Day Services Coordinator in writing regarding changes to the holiday schedule at least two weeks in advance of the County designated holiday. The Adult Day Services Coordinator will forward the “Holiday Schedule” and any changes in schedule to the Services for Adult Supervisor and to the DSS Senior Financial Analyst.

Adult Day Care Programs open on a County designated holiday will receive reimbursement providing that all of the following conditions are met: DSS is provided notice at least two weeks prior to the holiday that the program will be open for business; the customer actually attends the program on the holiday and the holiday falls on an enrolled day of service for the customer.

a. County designated holidays - (New Year's Day, Martin Luther King's Birthday, Good Friday, Memorial Day, Independence Day, Labor Day, Thanksgiving Day and the Friday afterwards, and 2 days for Christmas as designated by the Board of County Commissioners.)

b. Hazardous weather conditions - facility open for customers at the discretion of the Service Provider. Any change in the County operating hours will be communicated through the media.




http://www.ncdhhs.gov/aging/manual/ncfast/AdultDayCareServices.pdf


c. The Center will remain open during standard operating hours. If a Center is needing to close for any reason, the Center will contact the County ADC Monitoring staff or supervisor in advance

3. ConfidentialityService Provider’s confidentiality policies must be implemented to comply with DSS confidentiality regulations with regards to protection of customer information. Any information about a customer must be kept in strict confidence and used only in the capacity of specified responsibilities.

Customer records must be stored in a locked file located on site of the Adult Day Care Program and must be available for review upon request at the time of a DSS site visit or monitoring. Confidential customer information should not be released to any person not authorized to receive the information. The Service Provider needs to ensure that all employees assisting with DSS customers sign a statement agreeing to keep information in strict confidence and use the information only in the performance of his/her duties.

4. REPORTING ABUSE, NEGLECT, OR EXPLOITATIONService Provider’s program policies must be implemented to comply with DSS’s requirement to report all allegations of abuse, neglect or exploitation immediately to DSS by calling (704)336-3150. Inform the DSS Social Worker that a report has been made to Adult Protective Services Unit.

Fax all incident reports on any participant to the Adult Day Services Coordinator and the Health Care Specialist within 72 hours.

Information needed at the time of referral:

a. Name and address of customerb. Age or date of birthc. Caregiver’s name (if any)d. An explanation of the situation and why you feel the person needs protectione. Mental or physical condition of the adultf. Names of others who may help provide information regarding the situation (if

available)

Terms to Remember:

a. Abuse: The willful infliction of physical pain, injury, mental anguish, unreasonable confinement or willful deprivation by a caretaker of services, which are necessary to maintain mental and physical health.


b. Adult with a Disability: Is anyone over age 18 and physically or mentally incapacitated by their disability.

c. Caretaker Neglect: The failure of the caretaker to provide services necessary to avoid physical harm, mental anguish or mental illness to the disabled adult.

d. Exploitation: The illegal or improper use of an adult with a disability or his resources for another’s profit or advantage.

e. Self-Neglect: Involves an adult with disabilities living alone and without a caretaker and who is not able to provide necessary services to maintain his/her mental and physical health.

5. Subcontracting Service Provider shall not subcontract any of the work contemplated under this Contract without obtaining prior written approval from the Contract Administrator. Any approved subcontract shall be subject to all conditions of the Contract. Service Provider shall be responsible for the performance of any subcontractor.

6. Employee Criminal Search A statewide criminal history records search of all newly-hired employees for the past five (5) years shall be conducted by an agency approved by the North Carolina Administrative Offices of Courts as outlined in the North Carolina Adult Day Care/Day Health Services Standards for Certification manual revised July 1, 2007.

7. Employee Initial Drug TestAll newly-hired employees shall have an initial drug test. Employees after hire date will be randomly drug tested at the discretion of Service Provider. Service Provider will be responsible for arranging drug tests and for all costs.

D. CONSULTATION AND MONITORINGDSS will provide technical support and consultation to the Service Provider regarding customers and program operation.

1. Supportive Services Regarding Customers Include:a. Monitor care plans and make recommendations to ensure the customer’s needs

are being met.

b. Report needs and concerns of participants to DSS Social Worker.

c. Evaluate and plan with the customer/caregiver and program staff at least annually regarding the effectiveness of an ongoing need for program services.

2. Supportive Services Regarding Program Operation Include:


a. Monitor the facility and Service Provider records to ensure that the North Carolina Adult Day Care and Health Services Standards for Certification ; the Home and Community Care Block Grant (HCCBG) Procedures Manual for Community Service Providers; the State of North Carolina Division of Aging and Adult Services as outlined in the Fiscal Manual, Volume VI Service Administration Manual and the Family Services Manual and the Mecklenburg County Department of Social Services, Adult Day Care Program Procedures Manual for Contract Service Providers are met on an ongoing basis.

b. Assist the program in identifying and recommending ways to improve service

delivery.

c. Process invoices in a timely manner. Reconciliation is completed prior to issuing a payment to a Service Provider. Discrepancies may cause a delay in payment to the provider.

E. CORRECTIVE ACTIONDSS will implement a corrective action in accordance with the North Carolina Division of Aging and Adult Services standards:

A corrective action must be taken by the Service Provider for violation of standards identified by DSS. The Adult Day Services Coordinator and the Program Director must discuss the violation to assure the program’s clear understanding of the reason it was determined to be out of compliance, what change(s) needs to be made to bring the program into compliance, the date(s) by which the program’s corrective action must be completed, and the possible consequences if timely corrective action is not taken.

DSS will develop a written corrective action plan specifying what steps will be taken to bring the program into compliance. The plan is to be documented on the DSS-6215.

The Service Provider should be cautioned that failure to complete the corrective action will place it in a position of being in willful violation and that the certification law (G.S. 131D-6) specifies that “any person, firm, agency, or corporation that harms or willfully neglects a person under its care is guilty of a misdemeanor.

The Adult Day Services Coordinator is responsible for assuring that timely corrective action is taken. This must be done by means of a site visit to review the standard(s) which were not being complied with and the corrective action taken by the program. Documentation of the follow-up visit must be on the DSS-6215. When planned corrections have not been made within the time frame allowed, the program will be considered in willful violation of the standards and negative actions shall be taken by the North Carolina Division of Aging and Adult Services.

The Adult Day Services Coordinator must notify the North Carolina Division of Aging and Adult Services of the program’s failure to complete the corrective action plan by the established






http://www.ncdhhs.gov/aging/manual/adcadh/Standards2007.pdf

http://www.ncdhhs.gov/aging/manual/adcadh/Standards2007.pdf

deadline. The North Carolina Division of Aging and Adult Services will notify the program in a timely manner in the event that negative action is to be taken.

In the event that the Service Provider is in willful violation of any terms of conditions of the DSS contract, or in the event that there are audit findings due to willful non-compliance by the Service Provider, DSS will reserves the right to impose the following: a. Placing a hold on customer referralsb. Request contract termination

F. Negative Actions Per the North Carolina Division of Aging and Adult Services: Negative Actions against a program will be the responsibility of the North Carolina Division of Aging and Adult Services based on information submitted by the Adult Day Services Coordinator. Copies of any notice of negative action will be sent to the Service Provider.

1. Provisional Certification Certification status will be changed by the North Carolina Division of Aging and Adult Services to a provisional status under the circumstances set forth in Section VI.E of the Standards for Certification Manual. For two of the circumstances, the provisional status is designed to allow the program to continue operating for a designated period beyond its annual renewal date. A provisional certification may be granted to a program when the program does not meet all standards at the time of recertification, but the completion date of the corrective action is after the ending date of the certification period, and when the certification renewal package is incomplete or has not been received by the North Carolina Division of Aging and Adult Services in time for a thorough review prior to making the certification decision.

This will be done by the 15 day of the month in which the certificate would expire. In this way, it assures that certification continues without interruption until the program can be evaluated for compliance.

The other circumstance under which the certification status will be changed to provisional status is when the program has failed to complete corrective action within the established time frame and at that time, the program will be considered to be in willful violation of the standards. Procedures for revocation of certification and imposition of a penalty will be initiated as soon as this determination is made but, because of due process, revocation cannot take effect until 20 days after the program receives the revocation notice. In the interim between the notification of willful violation and the effective date of revocation, the program’s certification status will be changed to provisional. Provisional certification can be effective on the date of the program’s receipt of the notice of pending revocation.

2. Termination of Certification


a. Certification will automatically terminate at the end of a certification period if the North Carolina Division of Aging and Adult Services has not received the certification renewal package from the county by the last day of the certification period.

b. Certification will automatically terminate when the governing body changes. This

means when ownership in its entirety is transferred if it is a proprietary program or, if the program is a private nonprofit or public agency, when the board of directors is dissolved. This does not mean changes in board membership which occur in accordance with the by-laws of the corporation.

c. When the program moves to another location, certification will automatically terminate. The program should begin talking with the Adult Day Services Coordinator regarding the pending move. The Service Provider’s Program Director/designee should inform the Adult Day Services Coordinator and the North Carolina Division of Aging and Adult Services staff as soon as possible regarding the need for the program to relocate.

d. The Adult Day Services Coordinator shall inform the program well in advance of a move that it must follow certification procedures and submit its certification package within the required time frame for the new facility. Prompt submission of the required certification material through the county will avoid any delay in the review of the material by county and Division staff prior to making the certification decision.

3. Denial or Revocation of Certification A certificate may be denied or revoked at any time by the North Carolina Division of Aging and Adult Services for failure to comply with the standards.

A program must meet all standards in order to be certified initially. Certification will be denied by the North Carolina Division of Aging and Adult Services if all standards are not met. A notice to that effect will be sent to the program by personal delivery or certified mail and will become effective 20 days after the receipt of the notice.

When violations have not been corrected by the date established in a corrective action plan, the North Carolina Division of Aging and Adult Services may revoke a certificate. The revocation of certificate may become effective either by personal delivery or certified mail of the notice of revocation outlining the reasons for such action. Revocation will become effective 20 days after the program receives the notice. If the program is not closed by the effective date, unless an appeal has been properly filed, the Adult Day Services Coordinator must notify the North Carolina Division of Aging and Adult Services. When a program receives a notice of revocation, the Service Provider’s Program Director must inform each participant and participant caretaker, as appropriate, of the notice and the basis on which it was issued.


4. Summary Suspension In accordance with G.S. l50B-3(c), if the North Carolina Division of Aging and Adult Services find that the health, safety or welfare of the participants requires emergency action and incorporates this finding in its notice, the certificate may be summarily suspended. Notice of the summary suspension shall be affected by serving the Service Provider’s Program Director by personal delivery or certified mail, the summary suspension will be effective on the date specified in the notice or upon service of the notice, and whichever is later.

5. Penalty The North Carolina Division of Aging and Adult Services may impose a penalty upon receipt of information from the county, via Form DSS-6215, Adult Day Care and Day Health Notice of Violation Report, that the program continues to be out of compliance after the corrective action completion date.

The North Carolina Division of Aging and Adult Services may impose a penalty upon receipt of information from the county, via Form DSS-6215, Adult Day Care and Day Health Notice of Violation Report, that the program continues to be out of compliance after the corrective action completion date.

If a program is in willful violation, a penalty may be imposed. The amount of the penalty, within the limitation established by G.S. 131D-6, shall be determined based on the degree and extent of the harm or potential harm caused by the willful violation.

a. Where a violation presents a clear and immediate danger to the participants a civil penalty of $100 per day will be imposed effective from the day that the corrective action was to have been completed.

b. Where a violation has the potential to endanger the participants’ health, safety or welfare, a civil penalty of $50 per day will be imposed effective from the day the corrective action was to have been completed.

c. Where a violation does not directly endanger the participants, a civil penalty of $10 per day will be imposed effective from the date on which the corrective action was to have been completed.

The North Carolina Division of Aging and Adult Services shall determine the penalty levied against a program based on the severity of the violation as described above, and will notify the program by registered or certified mail. The penalty shall become due 20 days after receipt of the notice.

6. Appeals When a program is notified of a negative action by the North Carolina Division of Aging and Adult Services, the program may ask for an informal review by Division staff. The


request for the informal review may be made in person, by telephone, or in writing to the:

Adult Day Care Consultant Division of Aging and Adult Services 2101 Mail Service Center Raleigh, North Carolina 27699-2101 (919) 733-0440

If the review is not satisfactory, the program may request a hearing. The program may request a hearing within 60 days after receipt of written notification from the North Carolina Division of Aging and Adult Services of a negative action, by written notice through registered or certified mail to the:

Office of Administrative Hearings 424 North Blount Street Raleigh, North Carolina 27601

In addition, at any time before the hearing, the North Carolina Division of Aging and Adult Services may rescind the notice of negative action upon being satisfied that the reasons for such action have been corrected.

Upon receipt of a request for a hearing, the enforcement of a negative action will be suspended pending final agency decision. The petition for a hearing shall be filed with the Office of Administrative Hearings in accordance with G.S. 150B-23 and 26 NCAC 3.0003. In accordance with G.S. 1A-1, Rule 4(j)(4), the petition shall be served on a registered agent for service of process for the Department of Health and Human Services. A list of registered agents may be obtained from the Office of Legislative and Legal Affairs.

Procedures for processing an appeal of an adverse certification action and for the final decision are specified in G.S. 150B, Article 3 and 10 NCAC 1B.0200.

VII. SERVICE PROVIDER AGREEMENT POLICIES AND PROCEDURES

A. TERMDSS will contract for services with the Service Provider for the term of one (1) year, unless earlier terminated pursuant to the terms and conditions of the DSS contract. The proposed cost shall remain in effect for the duration of the contract unless there is change in funding.

B. REIMBURSEMENTReimbursement from DSS for services rendered to a customer will be provided if the customer completes an application and is found eligible. Authorization for service is not an automatic approval for Service Provider to begin billing for reimbursement. The service must be authorized on the DSS-5027 and the customer must attend the program prior to billing. The


number of days the customer is approved to attend the program may be adjusted by the DSS Social Worker based on availability of funds and changes in customer’s needs.

1. Rates are determined as follows:a. Adult Day Health will be reimbursed at the rate of $40.00 per day.

Adult Day Care will be reimbursed at the rate of $33.07 per day.

Transportation is an optional service and will be reimbursed at the rate of $1.50 per trip each way, $3.00 per round trip.

b. Per State regulations:

Service Providers cannot request reimbursement for holidays, weekends, or days when the Adult Day Care Program is scheduled to be closed.

c. The daily rate will be paid for the number of days each customer is authorized to attend the program as indicated on the DSS-5027.

i. Regardless of the funding source, if the customer is absent for 10 consecutive scheduled days based on enrollment as defined on the DSS 5027, after the 10th day, payment will discontinue until the customer resumes participation. Weekends, holidays, planned staff work days and days the program is closed due to hazardous weather conditions are not included when calculating consecutive scheduled days. Special consideration for continuation of services must be approved and assessed by the DSS Social Worker for customers absent for more than 30 days.

ii. Regardless of full-time or part-time enrollment, if a customer attends the program for a partial month due to a change in the customer status, payment will be based on enrollment as authorized on the DSS-5027.

d. Reimbursement may only be submitted for days that the program is operational. Service Provider may not submit for reimbursement for days when the program is closed due to holidays, hazardous weather, other emergency situations or other days as indicated in the program’s contract with the local DSS as outlined in the North Carolina Division of Aging and Adult Services Adult Day Care/Adult Day Health Services General Policies, Revised, May 2009

2. Service Codes determined as follows:SERVICE SERVICE CODE Unit of SERVICE

Adult Day Care 030 DAYAdult Day Health 155 DAYTransportation, Adult Day Care 031 One Way Trip


http://www.ncdhhs.gov/aging/manual/adcadh/ADCADHServiceStandards.pdf

http://www.ncdhhs.gov/aging/manual/adcadh/ADCADHServiceStandards.pdf

Transportation, Adult Day Health 156 One Way Trip

3. Conditions of payment:a. Prepare and submit monthly invoices along with monthly attendance record

summarizing services rendered from first day of the prior calendar month through the last day of the prior calendar month. This will include: number of DSS customers receiving Adult Day Care Program services and Transportation Services; number of authorized days of service; begin and end dates of service and the total amount of reimbursement being requested. The total amount paid under the terms of the Contract shall not exceed the actual expenditures incurred by the Service Provider.

The Service Provider must bill for units of services identified on the DSS-5027. If at any time the Service Provider bill in excess of units identified on the DSS-5027 or bill units for service when the customer has been absent from the program more than 10 consecutive days – DSS will recoup all over payments.

b. Invoices and attendance records must be received by DSS by the fifth (5 th) of the month for the previous month. Payment will be made within 30 days of date of invoice.

c. Upon receipt, the invoice will be validated and verified for accuracy and submitted to finance for payment. Incorrect invoices will be clarified with Service Provider with corrections/changes made on a revised invoice.

d. The date of the revised invoice will be considered as the original date of the invoice.

e. DSS will authorize approved amounts to be paid to Service Provider.

f. Failure to send requests to <[email protected]> may result in payment being delayed beyond 30 calendar days.

g. The first invoice will be due no later than August 15th for services rendered from July 1st through July 31st of the current year AND WILL BE PAID PROVIDING THE SERVICE PROVIDER HAS SUBMITTED THE CONTRACT, SUPPORTING DOCUMENTS AND THE CONTRACT HAS BEEN FULLY EXECUTED.

h. For services rendered from June 1st through June 30th of the previous year, the invoice will be due no later than July 5th of the current year. Late billings must be submitted for payment no later than sixty (60) calendar days from the date of service. If billing is over (60) calendar days, the County may deny payment.

C. Consumer Contributions


The purpose of Consumer Contributions as identified by the NC Division of Aging and Adult Services is to extend the availability of in-home and community based services by soliciting from recipients of specific services a portion of the cost for services rendered based upon their ability and willingness to contribute. Revenues collected by DSS from service recipients will be retained by DSS and used to increase services to existing customers and/or provide in-home and community based services to other individuals in need of such services.

1. No fees will be charged to individuals determined to be eligible for services by DSS under the Social Service Block Grant (SSBG) or HCCBG Program as defined in the Division of Aging and Adult Services Manual, Consumer Contributions Policy and Procedures.

2. The services under contract with the Service Provider are services that are subject to Consumer Contributions. If a customer participates in the Consumer Contributions, DSS will be responsible for establishing written policies and, procedures governing the collection of the Consumer Contributions Funds from all service recipients. DSS will document that reasonable efforts have been made to collect Consumer Contribution Funds.

3. Penalty fees for late pickup may not be assessed to a DSS customer, designated

representative of the customer or a DSS contracted Transportation Service Provider.

If the DSS contracted Transportation Service Provider has not arrived within 45 minutes of scheduled pick-up time or call time, the incident must be reported to the DSS Complaint line at 704-336-3040. For after hours (after 5:00pm) call DSS after Hours Line at 704-432-5198.

4. Service recipients will not be terminated for failure to pay the agreed upon Consumer Contributions amount if such an agreement has been made by or on behalf of the customer.

D. DonationsAccording to the NC Division of Aging and Adult Services, a donation can be in the form of cash, materials or other tangible items which have a defined value and are received from anyone other than Adult Day Care Program service recipients or their designated representatives (i.e. churches, the general public, family members of the service recipients, etc.).

A donation is not reported as a Consumer Contribution when it is not received from Adult Day Care Program service recipients or their designated representatives toward the cost of the Adult Day Care Program service(s) received. Adult Day Care Program service recipients or their designated representatives can make donations to support a service they are not receiving (for example field trips, haircuts, or other special programs offered for a separate fee).


http://www.ncdhhs.gov/aging/consumercontributions.htm

http://www.ncdhhs.gov/aging/consumercontributions.htm

To ensure the method of solicitation for donations are non-coercive, solicitation materials distributed to Adult Day Care Program service recipients and their designated representatives must include the following information:

1. How the donation will be used to expand services they are not receiving.

2. There is no obligation to make a donation and the donation is entirely voluntary.

3. Services will not be reduced or terminated for failure to make a donation.

4. Contact information for questions about the Donation Policy.

5. Each donation or lack of donation will remain confidential.

E. Performance StandardsReports on performance standards must be furnished by the Service Provider as requested by DSS on a regular basis.

Performance standards are a set of expectations that DSS has for Service Providers. The purpose of performance standards is to state what results are expected for performance to be considered satisfactory. These are expectations that DSS has for Service Providers in addition to the description of services agreed to by the Service Provider in each Contract.

The additional expectations include tracking outcomes, monitoring progress and presenting evidence to demonstrate that services are efficient and effective, and they are delivered using the County's Customer Service Standards which include: Service Quality, Timeliness, Courtesy and Respect, Clear Communication and Ethical Integrity.

DSS is committed to providing technical assistance to Service Providers for the achievement of continuous quality improvement. By agreeing to the terms and conditions of the Contract, Service Providers are required to accept this assistance when it is offered, and implement systems that target ongoing quality improvement. It is the intention of DSS to give Service Providers sufficient opportunity to improve performance as it relates to the following Performance Standards, and avoid the need to impose the consequences in each Contract.

APPENDIX: FORMS

DSS-5027 - Customer Entry Form PDF

DAAS-6205 - Part A – Program Certification Report PDF Interactive Word DOC

DAAS-6205 - Part B – Standards Review PDF Interactive Word DOC


http://www.ncdhhs.gov/aging/manual/adcadh/DAAS-6205-PartB-i.doc

http://www.ncdhhs.gov/aging/manual/adcadh/DAAS-6205-PartB.pdf

http://www.ncdhhs.gov/aging/manual/adcadh/DAAS-6205-PartA-i.doc

http://www.ncdhhs.gov/aging/manual/adcadh/DAAS-6205-PartA.pdf

http://info.dhhs.state.nc.us/olm/manuals/dss/rim-01/man/dss5027.pdf

DSS-6215 - Violation Form PDF Interactive Word DOC

DSS-601 – Complaint Investigation Report Form PDF Interactive Word DOC


http://www.ncdhhs.gov/aging/manual/adcadh/DAAS-601-Complaint_Investigation_Report-i.doc

http://www.ncdhhs.gov/aging/manual/adcadh/DAAS-601-Complaint_Investigation_Report.pdf

http://www.ncdhhs.gov/aging/manual/adcadh/DSS-6215-i.doc

http://www.ncdhhs.gov/aging/manual/adcadh/DSS-6215.pdf

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