CHAPTER 2400 Natural Supports Training Services

CHAPTER 2300
SPECIFIC PROGRAM REQUIREMENTS
FOR
INDIVIDUAL DIRECTED GOODS AND SERVICES
SCOPE OF SERVICES
2301 General
Individual Directed Goods and Services are goods and services not otherwise provided through the COMP or the Medicaid State Plan but are identified by the waiver participant/representative who opts for participant direction and the Support Coordinator or interdisciplinary team. These services are available only for participants who choose the participant-direction option for service delivery. Individual Directed Goods and Services must be clearly linked to an assessed need of the individual participant due to his or her disability and be documented in the participant’s Individual Service Plan.
Individual Directed Goods and Services are purchased from the participant-directed budget and cover services that include improving and maintaining the participant’s opportunities for full membership in the community. Goods and services purchased under this coverage may not circumvent other restrictions on COMP services, including the prohibition against claiming for the costs of room and board. Individual Directed Goods and Services must be authorized by the operating agency prior to service delivery.
The Individual Directed Goods and Services must:
 Decrease the need for other Medicaid services; AND
 Not be available through another source, including the participant not having the funds to purchase the item or service; AND
 Promote inclusion in the community; OR
 Increase the participant’s safety in the home environment;
The participant/representative must submit a request to the Support Coordinator for the goods or service to be purchased that includes the supplier/vendor name and identifying information and the cost of the service/goods. A paid invoice or receipt that provides clear evidence of the purchase must be on file in the participant’s records to support all goods and services purchased. Authorization for these services requires Support Coordinator documentation that specifies how the Individual Directed Goods and Services meet the above-specified criteria for these services. Participants receiving flexible support coordination are required to follow these same procedures.
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2302 Special Requirements of Participation
2302.1 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, Individual Directed Goods and Services providers must meet the following requirements:
1. Individual Providers of Individual Directed Goods and Services must:
a. Must be 18 years or older;
b. Have a minimum of a high school diploma or GED Equivalent;
c. Must have two years of professional work experience in the area of purchasing or related experience; OR
d. Have an applicable business license for goods provided.
2. Authorization Documentation: The vendor for Individual Directed Goods and Services assures receipt of a copy of the required Support Coordinator documentation for authorization of these services prior to service provision.
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.
4. Documentation of Services and Goods Purchased: A paid invoice or receipt that provides clear evidence of the purchase must be on file in the participant’s records to support all goods and services purchased.
2302.2 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, Individual Directed Goods and Services provider agencies must meet the following requirements:
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1. Agency Providers of Individual Directed Goods and Services must:
a. Have employees providing services that meet the above requirements for individual providers; OR
b. Have an applicable business license for goods provided.
2. Authorization Documentation: The agency vendor for Individual Directed Goods and Services assures receipt of a copy of the required Support Coordinator documentation for authorization of these services prior to service provision.
3. 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.
4. Documentation of Services and Goods Purchased: A paid invoice or receipt that provides clear evidence of the purchase must be on file in the participant’s records to support all goods and services purchased.
2303 Licensure
Individual Directed Goods and Services are provided by vendors with the applicable Georgia business license as required by the local, city or county government in which the services are provided.
2304 Special Eligibility Conditions
A. Individual Directed Goods and Services are only for participants who opt for participant-direction.
B. The specific goods and services provided under Individual Directed Goods and Services must be clearly linked to an assessed need of the individual participant due to his or her disability and be documented in the participant’s Intake and Evaluation approved Individual Service Plan (ISP).
C. The participant/representative must submit a request to the Support Coordinator for the goods or service to be purchased that will include the supplier/vendor name and identifying information and the cost of the service/goods.
2305 Prior Approval
1. Authorization for these services requires Support Coordinator documentation that specifies how the Individual Directed Goods and Services meet the requirements for purchase of this coverage specified below:
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a) The goods or services are not covered through the COMP Program or Medicaid State Plan; AND
b) The participant does not have the funds to purchase the item or service or the item or service is not available through another source; AND
c) The item or service would decrease the need for other Medicaid services; AND
d) Promote inclusion in the community; OR
e) Increase the participant’s safety in the home environment.
2. The Support Coordinator provides a copy of the above documentation to the vendor prior to service provision.
3. The above authorization procedures for the Support Coordinator must be followed for participants receiving flexible support coordination.
4. Individual Directed Goods and Services must be authorized prior to service delivery by the applicable DBHDD Regional Office at least annually in conjunction with the ISP development and any ISP revisions.
2306 Covered Services
Reimbursable Individual Directed Goods and Services include the following based on the assessed need of the participant and as specified in the approved ISP:
1. Goods that specifically relate to the participant’s needs due to his or her disability and are not otherwise provided through the COMP or the Medicaid State Plan.
2. Services that specifically relate to the participant’s needs due to his or her disability and are not otherwise provided through the COMP or the Medicaid State Plan.
2307 Non-Covered Services
1. Services or goods not related to the needs of the individual participant due to his or her disability.
2. Experimental or prohibited treatments.
3. Costs for room and board and other restrictions on COMP services.
4. Services otherwise provided through the COMP or the Medicaid State Plan, including additional units or costs beyond the maximum allowable for any COMP or Medicaid State Plan service.
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5. Items denied through the Durable Medical Equipment and other Medicaid State Plan programs due to the lack of medical necessity.
6. Educational services otherwise available through a program funded under 20 USC Chapter 3, section 1400 of the Individuals Education Act (IDEA), including private school tuition, Applied Behavior Analysis (ABA) in schools, school supplies, tutors, and home schooling activities and supplies.
7. Services that are available under a program funded under section 110 of the Rehabilitation Act of 1973.
8. Incentive payments, subsidies, or unrelated vocational training expenses.
9. Supervisory activities rendered as a normal part of the business setting.
10. Medically related services that are not allowable by State law, rules, and regulations.
11. Admission fees, Memberships, Subscriptions, Donations, or related items.
12. Training paid caregivers.
13. Services in a hospital.
14. Any item listed as non-covered for the COMP Specialized Medical Supplies, Specialized Medical Equipment, Vehicle Adaptations, and Environmental Accessibility Adaptation Services.
15. Services reimbursable by any other source.
16. Costs of travel, meals and overnight lodging for families and natural support network members to attend a training event or conference.
17. 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.
2308 Basis for Reimbursement
The reimbursement rate is the lower of three price quotes or the annual maximum. The reimbursement rate for Individual Directed Goods and Services is found in Appendix A.
A. The annual maximum number of units is 20.
B. Annual maximum is $1500.00.
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C. Limit: 1 unit = $1.00
2309 Participant-Direction Options
A. Individual Directed Goods and Services are only for participants who opt for the self-direction option.
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 Individual Directed Goods and Services.
For details on participant-direction, see Part II Policies and Procedures for COMP, Chapter 1200.

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