CHAPTER 2500 Prevocational Services

CHAPTER 2500
SPECIFIC PROGRAM REQUIREMENTS
FOR
PREVOCATIONAL SERVICES
SCOPE OF SERVICES
2501 General
Prevocational Services prepare a participant for paid or unpaid employment. These services are for the participant not expected to be able to join the general work force within one year as documented in the Individual Service Plan. If compensated, individuals are paid in accordance with the requirements of Part 525 of the Fair Labor Standards Act.
Prevocational Services occur in facility-based settings or at community sites outside the facility for small groups of participants, called mobile crews, who travel from the facility to these community sites. Mobile crews receive Prevocational Services by performing tasks, such as cleaning or landscaping, at community sites other than the participant’s home or family home or any residential setting.
The emphasis of Prevocational Services is directed to habilitative rather than explicit employment objectives. These services include teaching participants individual concepts necessary to perform effectively in a job in the community. Activities included in these services are directed at teaching concepts such as rule compliance, attendance, task completion, problem solving, endurance, work speed, work accuracy, increased attention span, motor skills, safety, and appropriate social skills.
The intended outcome of these services is to prepare the participant for paid or unpaid employment through increased skills. Prevocational Services are individually planned to meet the participant’s needs for preparation for paid or unpaid employment. These services are provided either facility-based or at community sites other than the participant’s home or family home or any other residential setting.
Prevocational Services are provided to groups of participants at a facility or to small groups of participants who travel to sites outside the facility, referred to as mobile crews. The staff to participant ratio for facility-based Prevocational Services cannot exceed one (1) to ten (10). The staff to participant ratio for Mobile Crew Prevocational Services cannot exceed one (1) to six (6). Prevocational Services Providers offer (or arrange when needed) any of the standard services
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listed in section 2505 – Covered Services that are needed by the participants served and specified in the participants’ Individual Service Plans.
2502 Special Requirements of Participation
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, Prevocational Services providers must meet the following requirements:
1. Staffing Qualifications and Responsibilities
Provider agencies rendering Prevocational Services must have staffing that meets the following requirements:
a. A designated agency director who must:
 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.
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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 Prevocational 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;
 Supervising the formulation of the participant’s plan for delivery of Prevocational 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 facility-based Prevocational Services and a minimum of one (1) direct care staff members for every six (6) participants served in Prevocational Services provided as mobile crews;
g. Direct Care Staff must:
 Be 18 years or older;
 Have 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 Prevocational Services, including related policies and procedures;
2) Confidentiality of individual information, both written and spoken;
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3) Rights and responsibilities of individuals;
4) Requirements for recognizing and reporting suspected abuse, neglect, or exploitation of any individual:
i. To the DBHDD;
ii. Within the organization;
iii. To appropriate regulatory or licensing agencies; and
iv. To law enforcement agencies
h. Duties of the Direct Care Staff include, but are not limited to:
 Provides direct assistance in teaching such concepts as rule compliance, attendance, task completion, problem solving, endurance, work speed, work accuracy, increased attention span, motor skills, and safety to groups of participants;
 Provides direct assistance in training appropriate social interaction skills required in the workplace to 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 participant-specific assistance, such as assistance with personal care and self-administration of medications.
i. 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 mobile crew Prevocational 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.
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k. 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.
2. Agency Policies and Procedures – Each provider agency must develop written policies and procedures to govern the operations of Prevocational 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 must document the following in the record of each participant receiving Prevocational 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. Prevocational Services and Other Services in the Same Facility:
a. Providers rendering facility-based Prevocational Services and other services (e.g., Community Access Services and adult therapy services) can provide these services in the same 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 waiver services may not receive
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these services at the same time of the same day.
5. Providers must meet the following requirements for staff-to-participant ratios:
a. Facility-Based Prevocational Services: a staff to participant ratio of one to two or more, not to exceed one (1) to ten (10).
b. Mobile Crew Prevocational Services: a staff to participant ratio of one to two or more, not to exceed one (1) to six (6).
c. The staff to participant ratio may be more intense than the upper limit indicated above; the actual ratio must be as indicated by the individualized needs of the participants.
6. DBHDD Contract/LOA and DBHDD Community Service Standards: 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 Accreditation) or certification by the DBHDD (see Part II Policies and Procedures for COMP, Chapter 603).
7. Fair Labor Standards Act Requirements: Providers must adhere to the requirements of Part 525 of the Fair Labor Standards Act as follows:
a. Meet all requirements for time rates, piece rates, commensurate wages and fair business practices.
b. Maintain Department of Labor certificates appropriate to the program provided and/or the individual if sub-minimum wage employment is provided.
c. Determines Special Minimum Wage as specified in the Fair Labor Standards Act.
8. Continuation of Prevocational Services: Effective July 1, 2009, any Individual Services Plan (ISP) for a participant who has a birthday on or after November 1st. 2009 and has received at least a year (12 months) of Prevocational Services must document the following assessment of necessity and adequacy of the continuation of Prevocational Services for the participant:
a. Consideration of the following by the support coordinator and interdisciplinary team developing the ISP:
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(1) Amount of time receiving Prevocational Services.
(2) Progress on any or all Prevocational Services goals in prior ISP.
(3) Interest of participant in working.
(4) Any prior receipt of Supported Employment Services.
b. Determination by the support coordinator and interdisciplinary team of continuance or discontinuance Services for the participant bases on the above assessment.
c. The provider of Prevocational Services for any participant for whom this section is applicable must maintain a copy of the required documentation in the participant’s record.
9. Physical Environment
Providers who render facility-based Prevocational 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,
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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;
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 Department of Human Services (DHS), 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:
 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;
 Kept in original containers with original labels intake or in labeled bubble packs from a pharmacy;
 Handled in accordance with current applicable State laws and regulations.
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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 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:
 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.
 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.
 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.
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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10. Transportation: The participant’s family or representative may choose to transport the member to the Prevocational Services facility.
11. 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 Prevocational Services site must be individually enrolled.
2503 Special Eligibility Conditions
A. Prevocational Services are available only for participants for whom the service is not available under a program funded under section 110 of the Rehabilitation Act of 1973 or the IDEA (20 U.S.C. 1401 et seq.). Documentation is maintained in the file of each participant receiving Prevocational Services that these services are not available through any of these programs.
B. Prevocational Services are for participants not expected to be able to join the general work force within one year as documented in the Individual Service Plan.
C. The need for Prevocational 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).
2504 Prior Approval
Prevocational Services must be authorized prior to service delivery by the applicable DBHDD Regional Office at least annually in conjunction with the Individual Service Plan (ISP) development and with any ISP revisions.
2505 Covered Services
Reimbursable Prevocational Services include the following based on the assessed need of the participant and as specified in the approved ISP:
1. Teaching such concepts as rule compliance, attendance, task completion, problem solving, endurance, work speed, work accuracy, increased attention span, motor skills, and safety.
2. Instruction in appropriate social interaction skills required in the workplace.
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3. Participant-specific assistance, such as assistance with personal care and self-administration of medications, as identified in the Individual Service Plan.
4. Facility-based training and/or assistance.
5. Mobile crews, which consist of a group of participants who engage in prevocational services by performing tasks, such as cleaning or landscaping, at community sites at sites outside the facility.
6. Transportation is required to and from the facility site (a reasonable amount of transportation, defined as up to one hour per day, is billable).
2506 Non-Covered Services
1. Prevocational Services are distinct from and do not occur at the same time of day as Community Access or Supported Employment services.
2. Services that are available under a program funded under section 110 of the Rehabilitation Act of 1973 or the IDEA (20 U.S.C. 1401 et seq.).
3. Medically related services that are not allowable by State law, rules, and regulations.
4. Prevocational Services may not be delivered in a participant’s own or family home or any residential site.
5. 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.
6. 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.
2507 Basis for Reimbursement
Reimbursement Rate: The reimbursement rate for Prevocational Services is found in Appendix A.
Transportation provided through these services is included in the cost of doing business and incorporated in the administrative overhead cost.
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A. A Unit of service is 15 minutes.
B. The daily maximum number of units is 24.
C. The monthly maximum number of units is 504.
D. The annual maximum number of units is 5,760.
2508 Participant-Direction Options
A. Prevocational Services are not eligible for any participant-direction option.
B. For details on participant-direction, see Part II Policies and Procedures for COMP, Chapter 1200.

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