CHAPTER 1900 Community Living Supports (CLS) Services

CHAPTER 1900
SPECIFIC PROGRAM REQUIREMENTS
FOR
COMMUNITY LIVING SUPPORT (CLS) SERVICES
SCOPE OF SERVICES
1901. General
Community Living Support (CLS) Services are individually tailored
supports that assist with the acquisition, retention, or improvement in
skills related to a participant; continued residence in his or her own or
family home. Personal care/assistance may be a component part of CLS
services but may not comprise the entirely of the services. CLS services
are offered to participants who live in their own or family home.
CLS services include training and assistance with activities of daily living
(ADLs), such as bathing, dressing toileting, and transferring, with
instrumental activities of daily living (IADLs), such as personal hygiene,
light housework, laundry, meal, preparation, transportation, grocery
shopping, using the telephone, and medication and money management.
These services include transportation to facilitate the individual’s
participation in grocery or personal shopping, banking and other
community activities that support continued residence of the participant in
his or her own or family home. CLS services may include medically
related services, such as basic first aid, arranging and transporting
participants to medically appointments, accompanying participants on
medical appointments, documenting a participant’s food and/or liquid
intake or output, reminding participants to take medication, assisting
with or supervising self-administration of medication and other medically related activities, including health maintenance activities . Personal
care/assistance may be a component part of CLS services but may not be the only service provided to a participant. The amount of personal care/assistance is specific to the individual needs of the participant, as determined by the Supports Intensity Scale, the Health Risk Screening Tool, and other participant-centered assessment data. The individual amount of personal care/assistance provided the participant is participant is specified in the Individual Service Plan. A personal assistance retainer is a Community Living Support Services.
A personal assistance retainer is a component of Community Living Support Services. The personal assistance retainer allows for continued payment for Community Living Support services while a participant is hospitalized or otherwise away from the home in order to ensure stability and continuity of care. This retainer allows continued payment to personal
Rev 01 2013
January 1, 2015 Comprehensive Supports Waiver Program (COMP) XX-2
caregivers under the waiver for up to thirty (30) days per calendar year for absences of participant from his or her home.
CLS services may also include nursing services. These nursing services differ in scope from skilled nursing services offered as a component of Home Health services in the State Medicaid Plan. CLS nursing services are those services that are not included under exceptions to the nurse practice act. These nursing services are not stand alone services and can only be provided as a component of Community Living Support Services. CLS nursing services must be provided in accordance with State law, rules, and regulations.
The types and intensity of services provided are specific to the individual participant and detailed in his or her Individual Service Plan. Community Living Support Services providers offer any of the standard services listed in section 1906 – Covered Services that are needed by the participants served and specified in the participants’ Individual Service Plans.
1902 Special Requirements of Participation
1902.1 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 Living Support Services providers must meet the following requirements:
1. Individual providers of Community Living Support Habilitation Services must:
b. 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 Living Support 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
Rev 01 2009
January 1, 2015 Comprehensive Supports Waiver Program (COMP) XX-3
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 Living Support services;
f. Meet transportation requirements in COMP Part II Chapter 900, Section 905 if transporting participants.
2. Individual providers of Community Living Support Nursing Services must:
a. Hold current Georgia professional license as a License Practical Nurse if providing CLS LPN services and provide services under the supervision of a registered nurse, licensed to practice in the State of Georgia.
b. Hold current Georgia professional license as a Registered Nurse if providing CLS RN services
3. Documentation Requirement: Providers, except for providers of participant-directed services, must document the following in the record of each participant receiving Community Living Support 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
Rev. 04 2009
Rev. 10 2009
Rev. 04 2010
Rev. 04 2010
Rev. 04 2010
Rev. 04 2010
January 1, 2015 Comprehensive Supports Waiver Program (COMP) XX-4
assistance/support in the Current Service Summary and the Health and Safety sections of the ISP.
4. Personal Assistance Retainer Documentation: Providers must document the following in the record of each participant for whom a personal assistance retainer is a component of Community Living Support Habilitation Services:
a. Beginning and end date of absence.
b. Reason for absence.
c. Scheduled days and units per day for Community Living Support Habilitation Services as specified in the ISP.
Note: See Chapter 1200 in Part II of the Comprehensive Support Waiver Program for Participant-Directed Personal Assistance Retainer documentation requirement.
For further clarification and information refer to Appendix C in this manual
5. Participant-Directed Services Documentation and other Requirements: Documentation, including Personal Assistance Retainer documentation and other requirements for individual providers of participant-directed services are specified in Part II Policies and Procedures for COMP, Chapter 1200.
1902.2 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 Living Support Services provider agencies must meet the following requirements:
1. Staffing Qualifications and Responsibilities
Provider agencies rendering Community Living Support Services must have staffing that meets the following requirements:
a. A designated agency director who must:
Rev. 04 2010
Rev. 04 2010
Rev. 04 2010
Rev 01 2013
January 1, 2015 Comprehensive Supports Waiver Program (COMP) XX-5
 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 in supervisory a capacity; or
a. Duties of the Agency Director include, but are not limited to:
b. Oversees the day-to-day operation of the agency;
c. Manages the use of agency funds;
d. Ensures the development and updating of required policies of the agency;
e Manages the employment of staff and professional contracts for the agency;
f. Designates another agency staff member to oversee the agency, in his or her absence.
g. At least one agency employee or professional under contract with the agency must:
o Be a Developmental Disability Professional (DDP) (for definition, see Part II Policies and Procedures for COMP, Chapter 1200 Appendix I);
o Have responsibility for overseeing the delivery of Community Living Support Services to participants.
h. The same individual may serve as both the agency director and the Developmental Disability Professional;
i. Duties of the DDP include, but are not limited to:
 Overseeing the services and supports provided to participants;
January 1, 2015 Comprehensive Supports Waiver Program (COMP) XX-6
 Supervising the formulation of the participant’s plan for delivery of Community Living Support Services;
 Conducting functional assessments; and
 Supervising high intensity services.
j. 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 Living Support 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. The Adult Protective Services Unit, Division of Aging Services, Department of Human Services
ii. To the Department of Behavioral Health and Developmental Disabilities;
iii. Within the organization;
iv. To appropriate regulatory or licensing agencies; and
v. To law enforcement agencies
k. Duties of the Direct Care Staff include, but are not limited to:
Rev. 04 2009
Rev. 01 2011
January 1, 2015 Comprehensive Supports Waiver Program (COMP) XX-7
 Provides direct assistance to the participant in self-help, socialization, and adaptive skills training, retention and improvement;
 Provides personal care and protective oversight and supervision;
 Implements the behavioral support plans of participants to reduce inappropriate and/or maladaptive behaviors and to acquire alternative adaptive skills and behaviors;
 Provides assistance and training on independent community living skills, such as personal hygiene, light housework, laundry, meal preparation, transportation, grocery shopping, using the telephone, and medication and money management.
l. 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 services.
m. CLS nursing staff must:
 Hold current Georgia professional license as a Practical Nurse if providing CLS LPN services and provide services under the supervision of a registered nurse, licensed to practice in the State of Georgia.
 Hold current Georgia professional license as a Registered Nurse if providing CLS RN services.
n. Duties of CLS nursing staff include CLS nursing services as defined in Section 1906.
o. CLS nursing services rendered by a CLS enrolled provider agency are provided by individual nurses employed by OR under professional contract with the CLS enrolled provider agency, OR by subcontract with another provider agency. When CLS nursing services are provided by subcontract with another provider agency, the CLS enrolled provider agency must meet ALL of the following:
(1) Maintenance of a personnel file on each nurse providing CLS nursing services, including any PRN nurses, that includes all information required as if the individual nurse was an employee
Rev. 04 2010
Rev. 04 2010
Rev. 04 2010
Rev. 07 2010
Rev. 07 2011
January 1, 2015 Comprehensive Supports Waiver Program (COMP) XX-8
(2) Provision of oversight and supervision equal to that for its own employees
(3) Documentation of the nurse’s qualifications, five year employment history or complete employment history if the person has not been employed five years, and any health testing and examination as required for other employees (including TB testing upon employment and annually thereafter)
(4) Provision and documentation of orientation, training prior to direct contact of participants, and annual training as provided for an employee
(5) Written specification detailing nursing services to be provided in subcontracted agreement
(6) Documentation of at least an annual performance evaluation
(7) Personnel file readily available for review
p. The type and number of all other staff associated with the organization (such as contract staff, consultants) are:
 Properly trained or credentialed in the professional field as required;
 Present in numbers to provide services and supports to participants as required;
 Experienced and competent in the services and support they provide.
 National criminal records check (NCIC) documentation for all employees and any volunteers who have direct care, treatment, or custodial responsibilities for participants served by the agency.
q. CLS services must be provided by an employee of the enrolled CLS provider agency or by individual obtained through an employment agency with the exception of CLS nursing services and participant-directed CLS services.
2. Agency Policies and Procedures – Each provider agency must develop written policies and procedures to govern the operations of Community Living Support 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
January 1, 2015 Comprehensive Supports Waiver Program (COMP) XX-9
of participant-directed services, must document the following in the record of each participant receiving Community Living Support 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. Personal Assistance Retainer Documentation: Providers must document the following in the record of each participant for whom a personal assistance retainer is a component of Community Living Support Services:
a. Beginning and end date of absence.
b. Reason for absence.
c. Scheduled days and units per day for Community Living Support Services as specified in the ISP.
For further clarification and information refer to Appendix C in this manual
5. Participant-Directed Services Documentation and other Requirements: Documentation, including Personal Assistance Retainer documentation and other requirements for providers of participant-directed services are specified in Part II Policies and Procedures for COMP, Chapter 1200.
6. 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 on
Rev. 10 2009
January 1, 2015 Comprehensive Supports Waiver Program (COMP) XX-10
Accreditation) or certification by DBHDD (see Part II Policies and Procedures for COMP, Chapter 603).
1903 Licensure
A. Provider agencies that render CLS Services must have a Private Home Care Provider License from the Department of Community Health, Healthcare Facilities Regulation Division (HFR)
B. CLS LPN services are provided by a Licensed Practical Nurse in accordance with the applicable Georgia license as required under OCGA Title 43-26-32.
C. CLS RN services are provided by a licensed Registered Nurse in accordance with the applicable Georgia license as required under OCGA Title 43-26-3.
Rev 04/10
1904 Special Eligibility Conditions
A. CLS services are provided only to participants who require in-home supports.
B. The need for CLS services must be reflected in the Intake and Evaluation Team approved Individual Service Plan (ISP).
C. A minimum of seven (7) hours within a 24 hour day is required for Community Living Support (CLS) Daily Services except as follows:
1. A minimum of six (6) hours within a 24 hour day is required for CLS Daily if at least six (6) hours of the daily service provided is personal care tasks (i.e. activities of daily living, such as bathing, dressing, toileting, and transferring);
2. A minimum of eight (8) hours within a 24 hour day is required for CLS Daily if at least seven (7) hours of the service is companion or sitter tasks;
3. A minimum of eight (8) hours within a 24 hour day is required for CLS Daily if at least seven (7) hours of the service are protective oversight and supervision services. (see section 1906 for definition of protective oversight and supervision).
The numbers of hours of services provided through CLS Daily services is participant specific and as specified in the ISP. The minimum number of hours specified above should not be
Rev. 01 2009
Rev. 04 2009
Rev 07 2009
January 1, 2015 Comprehensive Supports Waiver Program (COMP) XX-11
considered the set number of hours to provide each participant.
The above requirement for CLS daily will not be effective until the participant’s COMP Individual Service Plan (ISP) is developed.
Exceptions to the minimum number of hours required for Community Living Support (CLS) Daily Services may be granted through the DBHDD Division of Developmental Disabilities (see Part II COMP Policies and Procedures, Chapter 600, Section 607). Such exceptions will only be considered for participants living in their family’s home. These exceptional are granted on an individual participant basis and justification
1905 Prior Approval
Community Living Support Services must be authorized prior to service delivery by the applicable DBHDD Regional Office at least annually in conjunction with the Individual Service Plan development and with any ISP revisions.
1906 Covered Services
Reimbursable Community Living Support Services include the following based on the assessed need of the participant and as specified in the approved ISP:
1. Social and leisure skills development that assists the participant in planning and engaging in social and leisure activities as a part of home living in a community.
2. Adaptive skills development that assists the participant in community activities that are a part of home living in a community, such as community navigation, mobility, communication, understanding community signs/clues, and safety in the community.
3. Personal care and protective oversight and supervision in the person’s own or family home as a component part but not as the entirety of the services.
4. CLS protective oversight and supervision that are services provided by staff/employee present in the participant’s own or family home, which include protective care and watchful monitoring activities of participant’s functioning, the making and reminding a participant of medical appointments, intervention if a crisis arises for a participant, and supervision in the area of nutrition and self-administration of medications
Rev. 04 2009
Rev. 04 2009
Rev. 10 2011
Rev 10 2009
Rev. 10 2009
January 1, 2015 Comprehensive Supports Waiver Program (COMP) XX-12
and other medically related services including health maintenance activities.
5. Training in and personal care/assistance with activities of daily living (ADLs), such as bathing, dressing, toileting, and transferring, and with instrumental activities of daily living (IADLs), such as personal hygiene, light housework, laundry, meal preparation, transportation, grocery shopping, using the telephone, and medication and money management..
6. Medically related services, such as basic first aid, arranging and transporting participants to medical appointments, accompanying participants on medical appointments, documenting a participant’s food and/or liquid intake or output, reminding participants to take medication, and assisting with self-administration of medication.
7. Implementation of the behavioral support plan of a participant to reduce inappropriate and/or maladaptive behaviors and to acquire alternative adaptive skills and behaviors.
8. Transportation is required for participants living in their own home to facilitate the individual’s participation in grocery or personal shopping, banking, and other community activities that support continued home living; transportation is provided as specified in the ISP for participants living in their own home.
9. CLS RN services defined as only routine nursing services that are integral to meeting the daily needs of the participant in his or her own or family home, such as routine administration of medications by nurse or tending to the needs of a participant who is ill or requires attention to his or her medical needs on an ongoing basis.
10. CLS LPN services defined as only routine nursing services that are integral to meeting the daily needs of the participant in his or her own or family home, such as routine administration of medications by a nurse or tending to the needs of a participant who is ill or requires attention to his or her medical needs on an ongoing basis.
1907 Non-Covered Services
1. Community Living Support services may not be delivered to a person living in a home leased or owned by the service delivery
Rev. 07 2010
Rev. 04 2010
Rev. 07 2010
Rev 10 2013
January 1, 2015 Comprehensive Supports Waiver Program (COMP) XX-13
agency, by an employee or contractor of the service delivery agency, or by support staff hired under participant direction.
2. Community Living Support services may not be delivered in a rental room/apartment/home for the individual participant where access to the kitchen is restricted and there is no access to at least one bathroom.
3. Community Living Support services may not be delivered in foster homes, host homes, personal care homes, community living arrangements, or any other home/residence other than the participant’s own or family home, but in no instance, can the own or family home be a licensed Personal Care Home, a licensed Community Living Arrangement, a host home/life sharing arrangement that provides Community Residential Alternative Services, or a home leased or owned by the service delivery agency or by support staff hired under participant direction.
4. Educational and related services needed by children for whom the Department of Education is responsible.
5. CLS services that duplicate or are provided at the same time of the same day as Community Access or Supported Employment services.
6. Payment is not made for the cost of room and board, including the cost of building maintenance, upkeep and improvement.
7. 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.
8. Medically related services that are not allowable by State law, rules, and regulations.
9. Payment is not made for Personal Assistance Retainer outside of scheduled days and units per day for Community Living Support Services as specified in the ISP.
10. Payment of Personal Assistance retainer is not allowable for absences due to services that are reimbursable as other waiver and Medicaid State Plan services except for admissions to a general hospital or nursing facility in accordance with requirements specified below in Section 1908, Basis for Reimbursement.
11. Payment of Personal Assistance retainer beyond allowable days indicated below in Section 1908, Basis for Reimbursement.
Rev. 10 2009
Rev. 01 2011
Rev. 04 2010
Rev 01 2013
Rev 10 2013
January 1, 2015 Comprehensive Supports Waiver Program (COMP) XX-14
12. Payment of Personal Assistance retainer for CLS nursing services.
13. CLS nursing services that are not provided in accordance with State law, rules, and regulations.
14. Non-covered health maintenance activities are defined the Rules and Regulations for Proxy Caregivers Used in Licensed Healthcare Facilities, Chapter 111-8-100.
15. 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.
1908 Basis for Reimbursement
Reimbursement Rate: Reimbursement rates for CLS services, includes CLS nursing services, are found in Appendix A.
Note: Reimbursement for all CLS services, including nursing, can not exceed the annual maximum for this service or any annual amount associated with an exceptional rate.
Transportation is included in the rate for CLS services.
A. The unit of service is 15 minutes for CLS habilitation services or CLS nursing services or daily for CLS habilitation services.
B. The annual maximum number of units is 9002 fifteen-minute CLS habilitation fifteen-minute units.
C. Total amount of CLS habilitation and CLS fifteen-minute units billed per day or amount billed for a CLS habilitation daily unit cannot exceed $128.52.
A personal assistance retainer is a component of CLS services. This personal assistance retainer allows continued payment for Community Living Support services while a participant is hospitalized or otherwise away from the home in order to ensure stability and continuity of care. This retainer allows continued payment to personal caregivers under the waiver for the following: up to thirty (30) days per calendar year for other absences of the participant from his or her home. The personal assistance retainer only allows continued payment for the scheduled days and amounts of CLS services as indicated in the ISP. The provider
Rev. 04 2010
Rev. 04 2010
Rev. 04 2010
Rev. 04 2010
Rev 01 2013
Rev. 10 2011
Rev 01 2013
January 1, 2015 Comprehensive Supports Waiver Program (COMP) XX-15
must document specific days and units billed under the personal assistance retainer (see Appendix C for Procedures for Billing and Documenting Personal Assistance Retainer).
Self-Directed
Community Living Support: 1 unit = $1.00
Annual limit is as authorized in the individual budget up to an annual maximum of $46,909.
1909 Participant-Direction Options
A. Participants can choose the self-direction or co-employer options with CLS 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 CLS services.
C. For details on participant-direction, see Part II Policies and Procedures for COMP, Chapter 1200.
D. All CLS services, including CLS Habilitation, CLS LPN, and CLS RN services, are provided within the annual maximum.
Rev 01 2013

Comments are closed.