Administrator

Companion Services consist of non-medical care, supervision and socialization activities

provided to an adult on a one-on-one basis or in groups not to exceed three clients. This service must be provided in direct relation to the achievement of the client’s goals per his support plan. A companion provider may also assist the client with such tasks as self-care needs, meal preparation, laundry and shopping; however, these activities shall not be performed as discrete services. This service does not entail hands-on medical care.

Aide Providers may also perform light housekeeping tasks, incidental to the care and supervision of the client. The service provides access to community-based activities that cannot be provided by natural or other unpaid supports, and should be defined as activities most likely to result in increased ability to access community resources without paid support.

Respite service will be provided in the consumer’s own home, family home or foster home.

Reimbursement and monitoring documentation to be maintained by the provider:

1. Copy of claim(s) submitted for payment; and

2. Service log.

The provider must submit a copy of service log, monthly, to the waiver support

coordinator.

Supported Living Services provide training and assistance to support consumers in a

variety of activities that are necessary to establish, live in and maintain a household of their

choosing in the community. These services may include assistance with locating

appropriate housing, the acquisition, retention or improvement of skills related to activities

of daily living such as personal hygiene and grooming, household chores, meal preparation,

shopping, personal finances and the social and adaptive skills necessary to enable

consumers to reside on their own. A Functional Community Assessment, the basis for

identifying the types of training, assistance and the intensity of support, shall be completed

with the consumer prior to his or her move to a supported living arrangement. This

assessment shall be updated annually. A Housing Survey, the basis for surveying a

prospective home to ensure that it is safe will be completed and forwarded to the

consumer’s support coordinator within ten (10) working days of the selection. This survey

will be updated quarterly and made available for review by the support coordinator at the

time of the support coordinator’s quarterly home visit. These updates shall include a review

of the beneficiaries overall health, safety and well-being status. The financial profile is an

analysis of the household costs and revenue sources associated with maintaining a balanced

monthly budget for the consumer. The analysis will substantiate the need for a monthly

subsidy or initial start-up costs, and should be a source of information for determining

strategies for assisting the person in money management. WE will assist the consumer in

completing the Financial Profile and submitting it to the support coordinator no more that

10 days following the selection of housing by the consumer. Supported living coaching

services will provide in the consumer’s place of residence or in the community. For

reimbursement purposes WE will submit an invoice, A service log (time intervention log),

which shall be supported by progress notes including documentation of activities, supports

and contacts with the consumer, other providers and agencies with dates and times, and a

summary of support provided during the contact, any follow up needed and progress

toward achieving support plan goals and a copy of the Individual Implementation Plan (or

in the case of transition, a transition plan) at the time of the first full month and at least

annually thereafter at the time of the support plan update, and any time updates and

changes are made before they are implemented. The implementation plan will include the

data elements as described in the Handbook and in addition will contain information on the

frequency of the supported living service, how home, health and community safety needs

will be addressed and the supports needed to meet these needs, the method for accessing

the provider 24-hours per-day, 7-days per-week for emergency assistance, a description of

how natural and generic supports will be used to assist in supporting the consumer; and a

financial profile that includes strategies for assisting the person in money management,

when requested by the consumer or guardian, and the amount approved for the supported

living subsidy. For monitoring review purposes we will have a copy of the service logs

LIFE TOUCHING HOME CARE LLC Time Intervention Log for Clients

Keeping a time intervention log, for the period being reviewed, an individual implementation plan and/or transition plan, an annual written report, summarizing the consumer’s progress toward achieving the goal(s) from the support plan. The annual report shall include objective (fact-based) information reflecting the results of training and supports provided

over the course of the year, as well as subjective information (opinions) and recommendations. The annual report shall be submitted to the consumer or guardian and

any support coordinator 30 days prior to the end of the support plan year, an annual

satisfaction survey that addresses satisfaction with supported living services, documentation of a quarterly meeting in which the consumer, the waiver support coordinator review the current supported living services (this review will be documented in the progress notes contained in the service log), an initial housing survey containing quarterly updates of the consumer’s health and safety status which will be updated quarterly and made available to the waiver support coordinator at or prior to the quarterly meeting, up-to-date information regarding the demographic, health, medical and emergency information, and a complete copy of the current support plan, if approved by the consumer/guardian, for each consumer served and performance data on the selected service outcomes projected as defined in the handbook.

Each individual is unique and presents his or her own distinctive set of needs and desires.

Goals and objectives relevant to services provided are identified on the support plan with

the assistance of the consumer’s circle of supports. Once a client has chosen our agency to

provide services, and we are in receipt of a current support plan and service authorization

We enter both demographic information, goals to be addressed along with the short term

objectives that will be used to make progress on the goals, and training strategies that have

been identified by the consumer and circle of support for the consumer into the Medicaid

Waiver Provider Information System. In addition, information regarding from the service

authorization such as the service approved, number of units and rate approved is entered

into the system for tracking billing units. Data collection sheets are generated monthly for

staff which lists specific goals and objectives. The data collection sheets are used to collect

specific objective data on progress towards goals as stated on the support plan and are also

used to note discussions on personal outcome measures and projected outcomes. Narrative

progress notes are also completed as necessary. This information is entered into the

Medicaid Waiver Provider Information System monthly at a minimum and is used to

generate monthly progress reports that are sent to the Support Coordinator as

documentation for billing. Progress is reviewed and changes to goals and objectives are

made with appropriate by conferencing with the consumer and the support coordinator.

Services are provided as scheduled and identified in the support plan and the service

authorization and are provided at the convenience of the consumer.

When dictated by the log book for the service being provided, an implementation plan will

be completed with direction from the consumer and will contain information from the

consumer, the support plan, and other appropriate sources. The specific areas of training

and strategies used to meet the specific goals will be addressed within the implementation

plan.

The following data elements will be included as part of the Implementation Plan:

o The name, address, and contact information of the consumer

o The goals from the support plan that the service will address.

o The strategies used to assist the consumer in meeting the support plan goal(s)

o The system for data collection and assessment of progress

The implementation plan will be developed, at a minimum, within 30 days of the initiation

of the new service, or within 30 calendar days of the support plan effective date for

continuation of services and annually thereafter. A copy of the implementation plan,

approved by the recipient, shall be furnished to the recipient, guardian and to the waiver

support coordinator at the end of this 30-day period. The progress toward achieving the

goal(s) identified on the implementation plan shall be documented in daily progress notes

or quarterly summaries, as specified in each service description. Data supporting the

recipient’s progress or lack thereof, summarized in the quarterly summary shall be

available for review.

Documentation to be maintained by the provider:

1. Copy of claim(s) submitted for payment;

2. Service log, which includes documentation of activities, supports and contacts with the

recipient, other providers and agencies with dates and times, and a summary of support

provided during the contact, any follow up needed and progress toward achieving support

plan goals. This service log and progress notes shall be placed in the recipient’s record

prior to claim submission; and

3. Individual implementation plan, or in the case of transition, a transition plan within 30

days of the initiation of a new service or within 30 days of the support plan effective date

for continuation services and annually thereafter. A copy of the implementation plan,

approved by the individual or their guardian shall be furnished to the individual or their

guardian and to the waiver support coordinator at the end of the 30 day period.

In addition to the minimum required components of the individual implementation plan

described in the definitions section of the handbook, the individual implementation plan for

supported living coaching service must also contain the following:

1. The frequency of the supported living service;

2. How home, health and community safety needs will be addressed and the supports

needed to meet these needs to include a personal emergency disaster plan;

3. The method for accessing the provider 24-hours per-day, 7-days per-week for emergency

assistance;

4. A description of how natural and generic supports will be used to assist in supporting the

recipient; and

5. A financial profile that includes strategies for assisting the person in money

management, when requested by the recipient or guardian; and the amount approved for the

supported living subsidy. The financial profile is critical in determining whether or not the

housing selected by the recipient is within his financial means and will identify the need for

monthly subsidy which must be approved by the APD Area Office;

6. A quarterly written report, which summarizes quarterly activities and the recipient’s

progress toward achieving the goal(s) from the support plan. The annual report shall

include objective, fact-based, information reflecting the results of training and supports

provided to the recipient over the course of the quarter, as well as recommendations.

The third quarterly summary which includes a summary of the activities of the current and

previous quarters of the support plan and shall be considered the annual report.

7. The quarterly review which reflects activities completed at the quarterly home visit. This

review shall include: a review of the supported living services to ensure services are

assisting the individual with identified support plan goals, a review of the person’s

financial status including a review of the financial profile, financial records and the status

of the subsidy if provided, review of the individual’s health and safety status including

identified need for follow-up, a review of the housing survey. Documentation of the

quarterly home visit and subsequent recommendations shall be made in the individual’s

record.

8. An initial housing survey containing quarterly updates of the recipient’s health and

safety status. The housing survey will be updated quarterly and made available to the

waiver support coordinator at or prior to the quarterly meeting.

Documentation of the meeting and subsequent recommendations will be made in the

recipient’s record;

9. Up-to-date information regarding the demographic, health, medical and emergency

Policies and Procedures for LIFE TOUCHING HOME CARE LLC

information, and a complete copy of the current support plan, if approved by the recipient

or guardian, for each recipient served.

Documentation to be submitted to the waiver support coordinator by the provider:

1. Copy of service log or time intervention log, monthly

2. Copy of individual implementation plan or in the case of transition, a transition plan,

completed within 30 days of the initiation of a new service or within 30 days of the support

plan effective date for continuation services and annually thereafter; and

3. Third quarterly summary which includes a summary of the activities of the current and

previous quarters of the support plan and shall be considered the annual report.

Supported Employment Services provide training and assistance in a variety of activities

to support recipients in sustaining paid employment at or above minimum wage unless the

recipient is operating a small business. The supported employment provider assists with the

acquisition, retention or improvement of skills related to accessing and maintaining such

employment or developing and operating a small business. With the assistance of the

supported employment provider, the recipient is assisted in securing employment according

to their desired outcomes, including the type of work environment, activities, hours of

work, level of pay and supports needed.

Supported employment is conducted in a variety of settings, to include work sites in which

individuals, without disabilities, are employed.

Supported employment includes activities needed to sustain paid work at or above

minimum wage for recipients receiving waiver services, including supervision and training.

This training can focus on both the recipient’s needs, as well as providing consultation to

the employer to enhance supports natural to the workplace rather than imposing paid

supports. Supported employment providers will immediately notify the recipient’s waiver

support coordinator of any changes affecting the recipient’s income. The service provider

shall work with both the recipient and the respective support coordinator to maintain

eligibility under the DD waiver, as well as health and income benefits through the Social

Security Administration and other resources.

Annually a review of the consumer’s progress is done with the consumer to identify the

personal goals, needs and services of the consumer as well as progress made during the

previous support plan year. When dictated by the handbook for the service provided, an

annual report will be completed and provided to the consumer and the support coordinator.

Upon receipt of the approved support plan and cost plan from the district, the pertinent

information in the support plan along with a service authorization will be sent to the other

providers selected by the consumer. A dated copy of the service authorization will be

generated and placed in the central file. This will be replaced with the signed copy once it

is received from the provider. A copy of the support plan and the date stamped cost plan

will be placed in the file.

Documentation to be maintained by the provider:

1. Copy of claim(s) submitted for payment;

2. Service log

3. Quarterly summary, the third quarterly summary which includes a summary of the

activities of the current and previous quarters of the support plan and shall be considered

the annual report.

4. Documentation, in the form of a letter from Vocational Rehabilitation (VR)

Services or a case note detailing contact with a named VR representative, the date,

summary of conversation, etc., indicating a lack of available VR funding for supported

employment.