455 IAC 2 HCBS rulePreliminary changes

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 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

Promulgation of a revised rule

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)

What providers are affected:

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

New & Revised Sections:

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

Legal Responsibilities

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

Financial Responsibility

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

Person-Centered Planning

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

Personal Lifestyle Choices in settings

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 ofpayment if it would result in loss of any of the

personal needs allowance

Payment of Room & Board

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

Code of Ethics

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

Conflict of Interest

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

Paid Family Caregivers

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

Reports of Participant’s Death

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

Provider Termination

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

Participant Service Termination

Provider must continue to deliver services until:

new provider starts serviceparticipant terminate providerDA authorized termination of provider’s

service

Unsafe work environment:Provider may terminate services immediatelyProvider must contact:

Police, Emergency Services, and APS/DCS if appropriateFile an Incident Report with DA

Participant Service Termination

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

Participant Program Termination

Comments:

The “final” draft of 455 IAC2 will be posted on the Division of Aging’s website along with public hearings on proposed changes:

www.in.gov/fssa/da

Comments may be sent to: DAComments@FSSA.in.gov THANK YOU!

Questions?