CHAPTER 1700 Community Access Services

CHAPTER 1700
SPECIFIC PROGRAM REQUIREMENTS
FOR
COMMUNITY ACCESS SERVICES
SCOPE OF SERVICES
1701 General
Community Access Services has three distinct categories, Community Access Individual, Community Access Participant Directed Activity, and Community Access Group. Community Access services are individually planned to meet the participant’s needs and preferences for active community participation. Community Access services are provided outside the participant’s place of residence. These services can occur during the day, the evenings, and weekends. Services include design of activities and environments for the participant to learn and/or use adaptive skills required for active community participation and independent functioning. These activities include training in socialization skills as well as personal assistance as indicated in the Individual Service Plan (ISP). Community Access services cannot be provided in the participant’s home or family home, personal care home, community living arrangement, or group home.
Community Access Individual (CAI) services are provided to an individual participant, with a one-to-one staff to participant ratio. CAI services are directly linked to goals and expectations of improvement in skills. The intended outcome of CAI services is to improve the participant’s access to the community through increased skills, increased natural supports, and/or less paid supports. CAI services are designed to be teaching and coaching in nature. These services assist the participant in acquiring, retaining, or improving socialization and networking, independent use of community resources, and adaptive skills required for active community participation outside the participant’s place of residence. CAI services may include programming to reduce inappropriate and/or maladaptive behaviors. CAI services are not facility-based.
Community Access Group (CAG) services are provided to groups of individuals, with a staff to individual ratio of one to two or more. The direct care staff to individual ratio for Community Access Group services cannot exceed one (1) to ten (10) and is determined based on individual need level of the participants in the group. CAG services are designed to provide oversight, assist with daily living, socialization, communication, and mobility skills building and
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supports in a group. CAG services may include programming to reduce inappropriate and/or maladaptive behaviors. CAG services may be provided in a facility or a community as appropriate for the skill being taught or specific activity supported.
Community Access Participant Directed Activity services are for individuals who are participant directed and participate in authorized community activities as outlined in Section 1705—Covered Services in order to address functional impairment and/or therapeutic needs of the waiver participant.
Transportation to and from activities and settings primarily utilized by people with disabilities is included in Community Access services. This transportation is provided through Community Residential Alternative services for participants receiving these services. Transportation provided through Community Access Services is included in the cost of doing business and incorporated in the administrative overhead cost. When transportation is to and from other community destinations, separate payment for transportation only occurs when the COMP’s distinct Transportation Services are authorized.
All Community Access Services do not include educational services otherwise available through a program funded under 20 USC Chapter 3, section 1400 of the Individuals with Disabilities Education Act (IDEA). Community Access services must not duplicate or be provided at the same period of the day as Community Living Support, Supported Employment, Prevocational Services or Transportation services. An individual serving as a representative for a waiver participant in self-directed services may not provide Community Access services. Community Access services must be authorized prior to service delivery by the operating agency at least annually in conjunction with the Individual Service Plan development and with any ISP revisions.
The COMP Program is intended for those goods and services that are not covered by the State Medicaid Plan or those instances in which a participant’s need exceeds State Plan coverage limits and exceptions to the coverage limits are not available. Community Access Services Providers offer (or arrange when needed) any of the standard services listed in section 1705 – Covered Services that are needed by the participants served and specified in the participants’ Individual Service Plans.
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1702 Special Requirements of Participation
1702.1 Individual Provider
In addition to those conditions of participation in the Medical Assistance Program as outlined in Part I, Policies and Procedures for Medicaid/PeachCare for Kids Manual applicable to all Medicaid providers, Section 106 (General Conditions of Participation), and PART II, Chapter 600 Policies and Procedures for the COMP Program, Community Access Services providers must meet the following requirements:
1. Individual providers of Community Access services must:
a. Be 18 years or older;
b. Have current CPR and Basic First Aid certifications;
c. Have the experience, training, education or skills necessary to meet the participant’s needs for Community Access services as demonstrated:
i. Direct Support Professional (DSP) certification; or
ii. Copy of high school diploma/transcript or General Education Development (GED) diploma; and at least six (6) months of experience providing behavioral health related services to individuals with developmental disabilities, or documented experience providing specific supports to individuals with disabilities.
d. Have evidence of an annual health examination with signed statement from a physician, nurse practitioner, or physician assistant that the person is free of communicable disease;
e. Agree to or provide required documentation of a criminal records check, prior to providing Community Access services.
f. Meet transportation requirements in COMP Part II Chapter 900, Section 905 if transporting participants.
2. Documentation Requirement: Providers, except for
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Note: Effective with June 1, 2009 Individual Service Plans and plans developed thereafter, Community Access Individual Services cannot be provided in facilities.
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providers of participant-directed services, must document the following in the record of each participant receiving Community Access Services:
a. Specific activity, training, or assistance provided;
b. Date and the beginning and ending time when the service was provided;
c. Location where the service was delivered;
d. Verification of service delivery, including first and last name and title (if applicable) of the person providing the service and his or her signature;
e. Progress towards moving the participant towards independence by meeting the participant ISP, which includes person-centered goals, desired outcomes in the participant’s action plan, and the amount/type of assistance/support in the Current Service Summary and the Health and Safety sections of the ISP.
3. Participant-Directed Services Documentation and other Requirements: Documentation and other requirements for individual providers of participant-directed services are specified in Part II Policies and Procedures for COMP, Chapter 1200.
1702.2 Provider Agencies
In addition to those conditions of participation in the Medical Assistance Program as outlined in Part I, Policies and Procedures for Medicaid/PeachCare for Kids Manual applicable to all Medicaid providers, Section 106 (General Conditions of Participation), and PART II, Chapter 600 Policies and Procedures for the COMP Program, Community Access Services provider agencies must meet the following requirements:
1. Staffing Qualifications and Responsibilities
Provider agencies rendering Community Access Services must have staffing that meets the following requirements:
a. A designated agency director who must:
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 Have either a bachelor’s degree in a human service field (such as social work, psychology, education, nursing, or closely related field) and five years of experience in service delivery to persons with developmental disabilities, with at least two of these years serving in a supervisory capacity; or
 Have an associate degree in nursing, education or a related field and six years of experience in service delivery to persons with developmental disabilities, with at least two of these years serving in a supervisory capacity; or
b. Duties of the Agency Director include, but are not limited to:
 Oversees the day-to-day operation of the agency;
 Manages the use of agency funds;
 Ensures the development and updating of required policies of the agency;
 Manages the employment of staff and professional contracts for the agency;
 Designates another agency staff member to oversee the agency, in his or her absence.
c. At least one agency employee or professional under contract with the agency must:
 Be a Developmental Disability Professional (DDP) (for definition, see Part II Policies and Procedures for COMP, Appendix I);
 Have responsibility for overseeing the delivery of Community Access Services to participants.
d. The same individual may serve as both the agency director and the Developmental Disability Professional;
e. Duties of the DDP include, but are not limited to:
 Overseeing the services and supports provided to participants;
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 Supervising the formulation of the participant’s plan for delivery of Community Access Services;
 Conducting functional assessments; and
 Supervising high intensity services.
f. A minimum of one (1) direct care staff member for every ten (10) participants served in Group Community Access Services and minimum of one (1) direct care staff members for every one (1) participant served in Individual Community Access Services;
g. Direct Care Staff must:
 Be 18 years or older;
 Has high school diploma/equivalent (General Educational Development or GED)
 Meet transportation requirements in COMP Part II Chapter 900, section 905 if transporting participants.
 Be provided with a basic orientation prior to direct contact with participants and show competence in:
1) The purpose and scope of Community Access Services, including related policies and procedures;
2) Confidentiality of individual information, both written and spoken;
3) Rights and responsibilities of individuals;
4) Requirements for recognizing and reporting suspected abuse, neglect, or exploitation of any individual:
i. To the Department of Behavioral Health and Developmental Disabilities;
ii. Within the organization;
iii. To appropriate regulatory or licensing agencies; and
iv. To law enforcement agencies
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h. Duties of the Direct Care Staff include, but are not limited to:
 Provides direct assistance in self-help, socialization, and adaptive skills training, retention and improvement to individual participants and groups of participants;
 Provides direct assistance in training, retraining or improving the access to and use of community resources by individual participants or groups of participants;
 Implements the behavioral support plans of participants to reduce inappropriate and/or maladaptive behaviors and to acquire alternative adaptive skills and behaviors;
 Provides active support and direct assistance in participants’ participation in community social, recreational and leisure activities;
 Provides participant-specific assistance, such as assistance with personal care and self-administration of medications.
j. The agency has adequate direct care staff with First Aid and CPR certifications to assure having at least one staff person with these certifications on duty during the provision of facility-based or community-based Community Access services.
j. The type and number of all other staff associated with the organization (such as contract staff, consultants) are:
1) Properly trained or credentialed in the professional field as required;
2) Present in numbers to provide services and supports to participants as required;
3) Experienced and competent in the services and support they provide.
k. National criminal records check (NCIC) documentation for all employees and any volunteers who have direct care, treatment, or custodial responsibilities for participants
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served by the agency.
2. Agency Policies and Procedures – Each provider agency must develop written policies and procedures to govern the operations of Community Access services, which follow the Standards for the Georgia Department of Behavioral Health and Developmental Disabilities refer to Part II Policies and Procedures for COMP.
3. Documentation Requirement: Providers, except for providers of participant-directed services, must document the following in the record of each participant receiving Community Access Services:
 Specific activity, training, or assistance provided;
 Date and the beginning and ending time when the service was provided;
 Location where the service was delivered;
 Verification of service delivery, including first and last name and title (if applicable) of the person providing the service and his or her signature;
 Progress towards moving the participant towards independence by meeting the participant ISP, which includes person-centered goals, desired outcomes in the participant’s action plan, and the amount/type of assistance/support in the Current Service Summary and the Health and Safety sections of the ISP.
4. Participant-Directed Services Documentation and other Requirements: Documentation and other requirements for providers of participant-directed services are specified in Part II Policies and Procedures for COMP, Chapter 1200.
5. Co-Employer Provider Agencies: Co-Employer Provider Agencies cannot provide facility-based Community Access Service.
6. Community Access and Other Services in the Same Facility:
a. Providers rendering facility-based Community Access and other services (e.g., Prevocational Services and adult therapy services) can provide these services in the same
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facility; however, the services must be documented and billed separately, and any waiver participant receiving multiple services may not receive these services at the same time of the same day.
b. Providers may grant access to other Medicaid providers for the provision of services at the facility; however, the services must be documented and billed separately, and any waiver participant receiving multiple services may not receive these services at the same time of the same day.
7. Providers, except for providers of participant-directed services, must utilize methods, materials, and settings that meet the following:
a. Set positive expectations for life experiences of people with disabilities, which result in enhanced personal independence and productivity, greater active community participation, and/or increased community integration;
b. Facilitate the provision of participant-specific supports through a supports network;
c. Are appropriate to the chronological age of participants;
d. Are culturally normative as specified in each participant’s ISP.
8. Providers must meet the following requirements for staff-to-participant ratios:
a. Group Community Access Services: a staff to individuals ratio of one to two or more, not to exceed one (1) to ten (10). The staff to individual ratio may be more intense than the upper limit allowed; the actual ratio must be as indicated by the individualized needs of the participants.
b. Individual Community Access Services: a one-to-one staff to participant ratio.
9. DBHDD Contract/LOA and DBHDD Community Service Standards: Agency providers must adhere to DBHDD Contract/LOA, DBHDD Community Service Standards and all other applicable DBHDD Standards, including accreditation by a national organization (CARF, JCAHO, The Council, Council
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on Accreditation) or certification by DBHDD (see Part II Policies and Procedures for COMP, Chapter 603).
10. Physical Environment
Providers who render facility-based Community Access Services must provide these services in a facility that meets the following requirements:
a. Accessibility: Is accessible to and usable by participants and meets Americans with Disabilities Act (ADA) accessibility requirements for facilities.
b. Building Construction and Maintenance: Is constructed, arranged, and maintained so as to provide adequately for health, safety, access, and wellbeing of the participants.
c. Building Codes: Is in compliance with all local building codes and other applicable codes;
d. Lighting: Provides adequate lighting for participants’ activities and safety;
e. Ventilation: Is adequately ventilated at all times by either mechanical or natural means to provide fresh air and the control of unpleasant odors;
f. Floor Space: Has adequate floor space to safely and comfortably accommodate the number of participants for all activities and services provided in that space;
g. Furnishings: Has sufficient furniture for use by participants, which provide comfort and safety; are appropriate for population served, including any participants with physical, visual, and mobility limitations; and provide adequate seating and table space for participant activities in the facility, including dining if applicable; Is accessible to and usable by participants and meets Americans with Disabilities Act (ADA) accessibility requirements for facilities.
h. Environmental/Sanitation: Is in good repair and clean inside and outside of the facility, including being free from liter, extraneous materials, unsightly or injurious accumulations of items and free from pest and rodents;
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i. Temperature Conditions: Has an adequate central heating and cooling system or its equivalent at temperature ranges that are consistent with the individual health needs and comfort of participants:
j. Equipment Maintenance: Maintains all essential mechanical, electrical, and participant activity, care and support equipment in safe operating condition;
k. Drinking Fountain: Must have drinking fountain(s) approved by the Georgia DBHDD, Division of Public Health or provide access to single disposable cups to participants, with participants disposing of the used cups immediately after use;
l. Restrooms: Has a minimum of at least two toilets and lavatories available, with accessibility for individuals with physical and mobility limitations, including installed grab bars;
m. Participant Activities and Dining Space: Has one or more clean, orderly, and appropriate furnished rooms of adequate size designated for participant activities and, if applicable, dining. If the facility has a single room for participant activities and dining, the room provides sufficient space to accommodate both activities without interfering with each other;
n. Medication Storage: Assures that medications are:
1) Stored under lock and key at all times. A staff member may keep medications needed for frequent or emergency use. The provider stores medications that require refrigeration in a locked container in the refrigerator;
2) Kept in original containers with original labels intact or in labeled bubble packs from a pharmacy;
3) Handled in accordance with current applicable State laws and regulations.
o. Documentation of Self-Administration of Medications: The facility maintains documentation of all self-administration of medications supervised by facility staff. The documentation record must include the name of the
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medication, dosage, date, time, and name of the staff person who assists the participants in the self-administration of medications by the participant.
p. Evacuation Plan: The facility formulates a plan for evacuation of the building in case of fire or disaster. This plan is posted in a clearly visible place in each room. All employees are instructed and kept informed of their duties under the plan.
q. Food Services: The following only apply if the facility stores, prepares, or distributes food:
1) The facility observes and complies with all of the Rules of Department of Human Services (DHS), Public Health, Chapter 290-5-14, Food Service and any local health ordinances when engaged in the storage, preparation, and distribution of food.
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2) Meals and snacks are prepared either on site or under subcontract with an outside vendor who agrees to comply with the food and nutritional requirements. The facility posts its current Food Service Permit and inspection report or the subcontracted vendor’s current Food Service Permit and inspection report.
3) The facility has a designated kitchen area for receiving food, facilities for warming or preparing cold food, and clean–up facilities including hot and cold running water. The facility provides palatable, nutritious and attractive meals and snacks that meet the nutritional requirements of each member.
11. Transportation: The participant’s family or representative may choose to transport the member to the Community Access facility. Transportation is required between point of origin and activities in setting primary utilized by people with disabilities (a reasonable amount of transportation, defined as up to one hour per day, is billable). Point of origin is defined as any location that participants are available for pick-up that is safe and appropriate for the participant based on the approved Individual Service Plan.
12. Individual Site Enrollment: Part I Policies and Procedures for Medicaid/Peachcare for Kids require that each provider enroll at each location where services are provided to Medicaid members. Each individual, facility-based Community Access
Note. The Department will allow the facility to be exempted from the Food Service Permit requirement if all the facility does is use a microwave to heat up food participants bring to the facility.
This exception is allowed only if:
 The microwave oven is clean, in good repair, and free of unsanitary conditions
 The microwave oven is allowed for warming of permitted foods and beverages based on the provider’s internal policies and procedures.
 All food and utensils are handled in a sanitary manner.
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site must be individually enrolled. Individual site enrollment applies only to facility-based Community Access sites.
1703 Special Eligibility Conditions
A. Community Access Services are only for participants for whom the service is not available under a program funded under 20 USC Chapter 3, section 1400 of the Individuals with Disabilities Education Act (IDEA).
B. The need for Community Access Services must be related to the individual disability; services must be therapeutic in nature; and tied to a specific goal in the Intake and Evaluation Team approved Individual Service Plan (ISP).
1704 Prior Approval
Community Access services must be authorized prior to service delivery by the operating agency at least annually in conjunction with the Individual Service Plan development and with any ISP revisions.
1705 Covered Services
Reimbursable Community Access Services for the distinct categories include the following based on the assessed need of the participant and as specified in the approved ISP:
Community Access Group
1. Services in facility-based and community-based settings outside the participant’s own or family home or any other residential setting
2. Design and development of activities in any location outside the participant’s own or family home or any other residential setting that assist the participant to learn, use, and/or maintain adaptive skills required for active community participation and independent functioning, which includes services provided on behalf of a specific participant as well as direct services.
3. Assistance in acquiring, retaining, or improving self-help, socialization, and adaptive skills for active community participation and independent functioning outside the participant’s own or family home, such as assisting the participant with money
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management, teaching appropriate shopping skills, and teaching nutrition and diet information.
4. Assistance in acquiring, retaining, or improving access to and use of community resources that increases participation in integrated community activities, such as training and active support to use public transportation, banks, automated tellers, and restaurants.
5. Provision of oversight and assistance with daily living, socialization, communication, and mobility skills building and supports in a group.
6. Implementation of behavioral support plans to reduce inappropriate and/or maladaptive behaviors and to acquire alternative adaptive skills and behaviors.
7. Recreational and leisure activities that support the participant’s active, local community participation and are specific to an ISP goal and therapeutic in nature, such as teaching a participant how to participate in and take advantage of community social and recreational activities or providing active support for a participant in community recreational and leisure activities.
8. Facilitating volunteer roles in the community and participation in self-advocacy type activities.
9. Other related, participant-specific assistance, such as assistance with personal care and self-administration of medication, and nursing services and health maintenance activities as indicated in the approved Individual Service Plan.
10. Transportation is required between point of origin and activities in settings primarily utilized by people with disabilities (a reasonable amount of transportation, defined as up to one hour per day, is billable). Point of origin is defined as any location that participants are available for pick up that is safe and appropriate for the participant based on the approved Individual Service Plan.
Community Access Individual
1. Services in non-facility, community-based settings take place outside the participant’s own or family home or any other residential setting.
2. Design and development of activities in any non-facility, community- based location outside the participant’s own or family
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home or any other residential setting that assist the participant to learn, use, and/or maintain adaptive skills required for active community participation and independent functioning, which includes services provided on behalf of a specific participant as well as direct services.
3. Assistance in acquiring, retaining, or improving socialization, and adaptive skills for active community participation and independent functioning outside the participant’s own or family home, such as assisting the participant with money management, teaching appropriate shopping skills, using public transportation, and teaching nutrition and diet information.
4. Assistance in acquiring, retaining, or improving socialization and networking, independent use of community resources, and adaptive skills required for active community participation outside the participant’s place of residence.
5. Participant-specific teaching and coaching of skills for access to the community, including communication, mobility, money management, and shopping skills.
6. Implementation of behavioral support plans to reduce inappropriate and/or maladaptive behaviors and to acquire alternative adaptive skills and behaviors.
7. Teaching and coaching a participant how to participate in and take advantage of community social and recreational activities.
8. Facilitating volunteer roles in the community and participation in self-advocacy type activities.
9. Other related, participant-specific assistance, such as assistance with personal care and self-administration of medications, and nursing services, and health maintenance activities as indicated in the approved Individual Service Plan.
Community Access Participant Directed Activity
1. Services for individuals who are participant directed and participate in community activities designed to address functional impairment and/or therapeutic needs of the waiver participant, which include therapeutic camp programs, therapeutic support groups, and physical fitness and weight reduction programs.
2. Services are tied to an ISP goal.
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1706 Non-Covered Services
1. Educational services otherwise available through a program funded under 20 USC Chapter 3, section 1400 of the Individuals with Disabilities Education Act (IDEA), including private school tuition, Applied Behavior Analysis (ABA) in schools, school supplies, and tutors.
2. Activities, training, or services provided in the participant’s home or family home, or host home/life sharing arrangement, foster home, personal care home, community living arrangement, group home, or any other residential setting.”
3. Medically related services that are not allowable by State law, rules, and regulations.
4. Admission fees, Memberships, Subscriptions, Donations, or related items.
5. Registration Fees unless participant-directed services.
6 Out of state camps.
7. Community Access services must not duplicate or be provided at the same time of the same day as Community Living Support, Supported Employment, Prevocational Services or Transportation Services.
8. Payment is not made, directly or indirectly, to members of the individual’s immediate family, except as approved as indicated in Part II Policies and Procedures for COMP, Chapter 900.
9. Community Access Services may not be delivered to a participant by the same staff person who provides the participant Community Residential Alternative Services or by the individual/family providing the participant a host home/life sharing arrangement.
10. Non-covered health maintenance activities are defined in the Rules and Regulations for Proxy Caregivers Used in Licensed Healthcare Facilities, Chapter 111-8-100.
11. Payment is not made for those goods and services covered by the State Medicaid Plan except where a participant’s need exceeds State Plan coverage limits and exceptions to the coverage limits are not available.
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1707 Basis for Reimbursement
The reimbursement rate for Community Access Services is found in Appendix A.
Transportation provided through Community Access Services is included in the cost of doing business and incorporated in the administrative overhead cost.
A. The unit of service is 15 minutes.
B. Community Access Group Limits:
1. 24 fifteen-minute units per day.
2. 504 fifteen-minute units per month.
3. 5760 fifteen-minute units per year.
C. Community Access Individual Limits:
1. 40 fifteen-minute units per day.
2. 1440 fifteen-minute units per year.
D. Separate payment for transportation only occurs when the COMP’s distinct Transportation Services are authorized.
Self-Directed
Community Access Group Limits: 1 unit = $1.00
Annual limit is as authorized in the individual budget
up to an annual maximum of $17,510.
Community Access Individual Limits: 1 unit = $1.00
Annual limit is as authorized in the individual budget
up to an annual maximum of $10,454.
Note. The limits for daily dollars/units do not apply to Self-Directed Community Access Services.
1708 Participant-Direction Options
A. Participants can choose the self-direction or co-employer options with Community Access Services.
B. An individual serving as a representative for a waiver participant in self-directed services is not eligible to be a participant-directed provider of Community Access Services.
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C. For details on participant-direction, see Part II Policies and Procedures for COMP, Chapter 1200.

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