CHAPTER 2600 Respite Services

CHAPTER 2600
SPECIFIC PROGRAM REQUIREMENTS
FOR
RESPITE SERVICES
SCOPE OF SERVICES
2601 General
Respite Services provide brief periods of support or relief for caregivers of individuals with disabilities. Respite is provided in the following situations:
1) When families or the usual caretakers are in need of additional support or relief;
2) When the participant needs relief or a break from the caretaker;
3) When a participant is experiencing severe behavioral challenges and needing structured, short-term support;
4) When relief from care giving is necessitated by unavoidable circumstances, such as a family emergency.
Planned or scheduled respite, or Maintenance Respite, provides brief periods of support or relief for caregivers or participants. Respite Services might also be needed to respond to emergency situations. Emergency Respite is intended to be a short term service for a participant who requires a period of structured support, or when respite services are necessitated by unavoidable circumstances, such as a family emergency. Maintenance Respite and Emergency Respite may be provided In-Home (provider delivers service in participant’s home) or Out-Of-Home (participant receives service outside of their home).
Respite Services may be provided in the participant’s own or family home, or outside the participant’s home in a private residence of a Respite Services provider (i.e., a home that is owned or rented by the provider or an employee of the provider) or in a licensed Personal Care Home, Community Living Arrangement, or Child Caring Institution. Respite Services include short-term services during a day or overnight services. Respite Services Providers offer any of the standard services listed in section 2606 – Covered Services that are needed by the participants served and specified in the participants’ Individual Service Plans.
2602 Special Requirements of Participation
2602.1 In-Home Respite Services Provider
Providers who render Respite Services in the participant’s own or family home must meet the following requirements:
1. Individual Provider of In-Home Respite Services
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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 providers of in-home Respite Services must meet the following requirements:
a. Individual providers of in-home Respite Services must:
1) Be 18 years or older;
2) Have current CPR and Basic First Aid certifications;
3) Have the experience, training, education or skills necessary to meet the participant’s needs for Respite Services as demonstrated by;
(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 service to individuals with developmental disabilities, or documented experience providing specific supports to individuals with disabilities.
4) 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;
5) Agree to or provide required documentation of a criminal records check, prior to providing Respite services;
6) Meet transportation requirement in COMP Part II Chapter 900, Section 905 if transporting participants.
b. Documentation Requirement: Providers, except for providers of participant-directed services, must document the following in the record of each participant receiving Respite Services:
1) Specific activity, training, or assistance provided;
2) Date and the beginning and ending time when the service was provided;
3) Location where the service was delivered;
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4) Verification of service delivery, including first and last name and title (if applicable) of the person providing the service and his or her signature;
5) 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.
c. 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.
2. Provider Agencies of In-Home Respite Services
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 and in addition to the staffing requirements for Private Home Care Licensure, provider agencies who render in-home Respite Services must meet the following requirements:
a. Staffing Qualifications and Responsibilities
Provider agencies rendering in-home Respite Services must have staffing that meets the following requirements:
1) 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.
2) Duties of the Agency Director include, but are not limited to:
 Oversees the day-to-day operation of the agency;
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 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.
3) 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 Respite Services to participants.
4) The same individual may serve as both the agency director and the Developmental Disability Professional;
5) 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 Respite Services;
 Conducting functional assessments; and
 Supervising high intensity services.
6) Direct Care Staff must:
 Be 18 years or older;
 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:
i. The purpose and scope of Respite Services, including related policies and procedures;
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ii. Confidentiality of individual information, both written and spoken;
iii. Rights and responsibilities of individuals;
iv. Requirements for recognizing and reporting suspected abuse, neglect, or exploitation of any individual:
1. To the DBHDD;
2. Within the organization;
3. To appropriate regulatory or licensing agencies; and
4. To law enforcement agencies
7) Duties of the Direct Care Staff include, but are not limited to:
 Provides participant-specific assistance, such as assistance with activities of daily living and self-administration of medications;
 Provides direct assistance in participants’ participation in community social, recreational and leisure activities;
 Implements the behavioral support plans of participants to reduce inappropriate and/or maladaptive behaviors and to acquire alternative adaptive skills and behaviors.
8) 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 Respite Services.
9) The type and number of all other staff associated with the organization (such as contract staff, consultants) are:
a) Properly trained or credentialed in the professional field as required;
b) Present in numbers to provide services and supports to participants as required;
c) Experienced and competent in the services and support they provide.
10) The agency must assure that participants have access to appropriate provider staff and access to 24 hour emergency services.
11) 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.
b. Agency Policies and Procedures – Each provider agency must develop written policies and procedures to govern the operations of Respite Services, which follow the Standards for DBHDD refer to Part II Policies
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and Procedures for COMP.
c. Documentation Requirement: Providers must document the following in the record of each participant receiving Respite Services:
1) Specific activity, training, or assistance provided;
2) Date and the beginning and ending time when the service was provided;
3) Location where the service was delivered;
4) Verification of service delivery, including first and last name and title (if applicable) of the person providing the service and his or her signature;
5) Progress towards moving the participant towards independence by meeting the participant’s 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.
d. Participant-Directed Services Documentation Procedures and other Requirements:
Documentation procedures and other requirements for co-employer providers of participant-directed services are specified in Part II Policies and Procedures for COMP, Chapter 1200.
e. 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 Accreditation) or certification by the DBHDD (see Part II Policies and Procedures for COMP, Chapter 603).
2602.2 Out-of-Home Respite Services Provider
Providers who render Respite Services outside the participant’s own or family home must meet the following requirements:
1. Individual Provider of Out-of-Home Respite Services
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
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PART II, Chapter 600 Policies and Procedures for the COMP Program, individual providers of out-of-home Respite Services must meet the following requirements:
a. Individual providers of Respite Services must:
1) Be 18 years or older;
2) Have current CPR and Basic First Aid certifications;
3) Have the experience, training, education or skills necessary to meet the participant’s needs for Respite 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 service to individuals with developmental disabilities, or documented experience providing specific supports to individuals with disabilities.
4) 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;
5) Agree to or provide required documentation of a criminal records check, prior to providing Respite services;
6) Meet transportation requirements in the COMP Part II Chapter 900, Section 905 if transporting participants.
b. Documentation Requirement: Providers, except for providers of participant-directed services, must document the following in the record of each participant receiving Respite Services:
1) Specific activity, training, or assistance provided;
2) Date and the beginning and ending time when the service was provided;
3) Location where the service was delivered;
4) Verification of service delivery, including first and last name and title (if applicable) of the person providing the service and his or her signature;
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5) 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.
c. 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.
d. Out-of-Home Respite Services Site: Individual providers render out-of-home Respite Services only in the private residence of the provider.
e. Respite Home Capacity Limit: Individual providers and providers of participant-directed services who render out-of-home Respite Services serve no more than one (1) individual in the home at a time. Exceptions to the private residence capacity limit up to two (2) individuals when serving only individuals under the age of 18 may be granted through the DBHDD, Division of Developmental Disabilities (see Part II Policies and Procedures for COMP, Chapter 600, Section 607).
f. Overnight Respite Home Physical Standards: With the exception of providers of participant-directed services, individual providers who render out-of-home, Overnight Respite Services must meet the following physical standards of the home:
a) Each home must be located in a residential community not solely inhabited by persons with disabilities.
b) The home must be accessible to the participant served.
c) The home is maintained in a condition to ensure the health and safety of the participant.
d) Hazardous items are not accessible to the participant.
e) Sleeping arrangements, such that
i. Only a bedroom is used as sleeping space for a participant.
ii. No participant under the age of eighteen (18) years sleeps in a room with an adult.
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iii. There must be no more than two individuals per bedroom, and these individuals must be the same gender.
g. Overnight Respite Home Site Inspections: With the exception of providers of participant-directed services, individual providers who render out-of-home, Overnight Respite Services must meet the following requirements:
1) Initial Site Inspection: Designated DBHDD Regional Office staff conduct the initial inspection for the above Physical Standards requirements of private residences of an individual provider prior to the rendering of Overnight Respite Services and send approval documentation to the DBHDD Regional Coordinator or designee.
2) Re-Inspections of Site: Individual providers who render out-of-home Respite Services must re-inspect semiannually the private residence service site for the above Physical Standards requirements, document the meeting of these requirements, and make available documentation for review by Support Coordinators, and DBHDD and DCH staff.
2. Provider Agencies of Out-of-Home Respite Services
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, provider agencies who render out-of-home Respite Services must meet the following requirements:
a. Staffing Qualifications and Responsibilities
Provider agencies rendering out-of-home Respite Services must have staffing that meets the following requirements in addition to any applicable licensure requirements:
1) 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 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
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persons with developmental disabilities, with at least two of these years serving in a supervisory capacity.
2) 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.
3) 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 Respite Services to participants.
4) The same individual may serve as both the agency director and the Developmental Disability Professional;
5) 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 Respite Services;
 Conducting functional assessments; and
 Supervising high intensity services.
6) Direct care staff to participant ratio will be based on the individual needs of the participant as specified in the ISP but a minimum of one (1) direct care staff member for every four (4) participants;
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7) Direct Care Staff must:
 Be 18 years or older;
 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:
a) The purpose and scope of Respite Services, including related policies and procedures;
b) Confidentiality of individual information, both written and spoken;
c) Rights and responsibilities of individuals;
d) 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
8) Duties of the Direct Care Staff include, but are not limited to:
 Provides participant-specific assistance, such as assistance with activities of daily living and self-administration of medications;
 Provides direct assistance in participants’ participation in community social, recreational and leisure activities;
 Implements the behavioral support plans of participants to reduce inappropriate and/or maladaptive behaviors and to acquire alternative adaptive skills and behaviors.
9) 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 Respite Services.
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10) The type and number of all other staff associated with the organization (such as contract staff, consultants) are:
a) Properly trained or credentialed in the professional field as required;
b) Present in numbers to provide services and supports to participants as required;
c) Experienced and competent in the services and support they provide.
11) The agency must assure that participants have access to appropriate provider staff and access to 24 hour emergency services.
12) 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.
b. Agency Policies and Procedures: Each provider agency must develop written policies and procedures to govern the operations of Respite Services, which follow the Standards for the Georgia Department of Behavioral Health and Developmental Disabilities refer to Part II Policies and Procedures for COMP.
c. Documentation Requirement: Providers, except for co-employer providers of participant-directed services, must document the following in the record of each participant receiving Respite 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.
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d. Participant-Directed Services Documentation and other Requirements: Documentation and other requirements for co-employer providers of participant-directed services are specified in Part II Policies and Procedures for COMP, Chapter 1200.
e. 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 Accreditation) or certification by the DBHDD (see Part II Policies and Procedures for COMP, Chapter 600, Section 603).
f. Out-of-Home Respite Services Site: Co-employer providers of participant-directed services render out-of-home Respite Services only in the private residence of the provider (i.e., a home owned or rented by the provider or an employee of the provider).
g. Respite Home/Facility Capacity Limit:
1) Respite Services provided in the private residence of a provider serve no more than one (1) individual in the home at a time.
2) Exceptions to the private residence capacity limit up to two (2) individuals when serving only individuals under the age of 18 may be granted through the DBHDD, Division of Developmental Disabilities (see Part II Policies and Procedures for COMP, Chapter 600, Section 607).
3) Respite Services provided in Personal Care Homes, Community Living Arrangements and Child Caring Institution serve no more than a total of four (4) individuals at a time.
h. Respite Services in Personal Care Home or Community Living Arrangement: Respite services in personal care homes and community living arrangements must and community living arrangements meet the following requirements:
 Respite services can only be rendered in personal care homes and community living arrangements in which all residents are adults with intellectual developmental disabilities.
 Each individual Personal Care Home and Community Living Arrangement site in which Respite services are rendered must be individually enrolled.
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i. Overnight Respite Home Physical Standards: With the exception of co-employer providers of participant-directed services, agency providers who provide Overnight Respite Services outside the participant’s home must meet the following physical standards requirements for homes:
 Agency providers who render Respite Services in a Personal Care Home meet the requirements of Section i. of these policies by maintaining licensure (State of Georgia Rules and Regulations 111-8-62).
 Agency providers who render Respite Services in a Community Living Arrangement meet the requirements of Section i. of these policies by maintaining licensure (State of Georgia Rules and Regulations 290-9-37),
 Agency providers who render Respite Services in a Child Caring Institution meet the requirements of Section i. of these policies by maintaining licensure (State of Georgia Rules and Regulations 290-2-5).
 Provider agencies that render out-of-home Respite Services in foster care settings for participants under the age of 19 years meet the requirements of Section i. of these policies by maintaining a Child Placing Agency License (State of Georgia Rules and Regulations 290-9-2).
 Agency providers who render Respite Services outside the participant’s home in a private residence of the provider must meet the following requirements:
1) Each home must be located in a residential community not solely inhabited by persons with disabilities.
2) The home must be accessible to the participant served.
3) The home is maintained in a condition to ensure the health and safety of the participant.
4) Hazardous items are not accessible to the participant.
5) Sleeping arrangements, such that
a) Only a bedroom is used as sleeping space for a participant.
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b) No participant under the age of eighteen (18) years sleeps in a room with an adult.
c) There must be no more than two individuals per bedroom, and these individuals must be the same gender.
j. Overnight Respite Home Site Inspections: With the exception of co-employer providers of participant-directed services and providers rendering Overnight Respite Services in Personal Care Homes, agency providers must meet the following requirements:
1) Initial Site Inspection: Support Coordinators/Planning List Administrators (or other designated DBHDD Regional Office staff) conduct the initial inspection for the above Physical Standards requirements of a private residence of the provider or an employee of the provider prior to the rendering of Overnight Respite Services and send approval documentation to the DBHDD Regional Coordinator or designee.
2) Re-Inspections of Site: Agency providers must re-inspect semiannually private residences of the provider or an employee of the provider for the above Physical Standards requirements, document the meeting of these requirements, and make available documentation for review by Support Coordinators, and DBHDD and DCH staff.
2603 Licensure
A. Provider agencies that render Respite Services in the participant’s own or family home must have a Private Home Care Provider License from the Georgia Department of Community Health, Healthcare Facility Regulation Division (HFR) if providing covered services as required by HFR (State of Georgia Rules and Regulations 290-5-54).
B. Provider agencies that render out-of-home Respite Services in a Personal Care Home must have a Personal Care Home Provider License from the Georgia Department of Community Health, HFR (State of Georgia Rules and Regulations 111-8-2).
C. Provider agencies that render out-of-home Respite Services in a Community Living Arrangement must have a Community Living Arrangement License from the Georgia Department of Community Health, HFR (State of Georgia Rules and Regulations 290-9-37).
D. Provider agencies that render out-of-home Respite Services in a Child Caring Institution must have a Child Caring Institution License from the Georgia
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Department of Human Services, Office of Inspector General, Residential Child Care Section (State of Georgia Rules and Regulations 290-2-5).
E. Provider agencies that render out-of-home Respite Services in foster care settings for participants under the age of 19 years must have a Child Placing Agency License from the Georgia Department of Human Services, Office of Inspector General, Residential Child Care Section (State of Georgia Rules and Regulations 290-9-2).
2604 Special Eligibility Conditions
The need for Respite Services must be reflected in the Intake and Evaluation Team approved Individual Service Plan (ISP).
2605 Prior Approval
Respite 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.
2606 Covered Services
Reimbursable Respite Services include the following based on the assessed need of the participant and as specified in the approved ISP:
1. Planned or scheduled respite, or Maintenance Respite, that provides brief periods of support or relief for caregivers or participants (1) when families or the usual caretakers are in need of additional support or relief; or (2) when the participant needs relief or a break for the caretaker.
2. Short-term Emergency Respite that provides a period of structured support for a participant experiencing severe behavioral challenges or brief periods of support for participant due to unavoidable circumstances, such as a family emergency.
3. Maintenance Respite and Emergency Respite services are short-term services during a day or overnight services that include but are not limited to:
a. Participant-specific assistance, such as assistance with activities of daily living, self-administration of medications, and health maintenance activities;
b. Direct assistance in participants’ participation in community social, recreational and leisure activities;
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c. Implementation of the behavioral support plans of participants to reduce inappropriate and/or maladaptive behaviors and to acquire alternative adaptive skills and behaviors.
2607 Non-Covered Services
1. Services in a personal care home, community living arrangement, or child caring institution serving more than four individuals.
2. Services in the private residence of a provider serving more than one participant, unless a waiver granted to serve two (2) participants under the age of 18.
3. Services provided in hospitals, ICF/ID facilities, psychiatric facilities, assisted living facilities, and nursing homes.
4. Services in a facility or host home providing residential services through the Comprehensive Supports Waiver (COMP).
5. Services rendered by an individual provider in a licensed Personal Care Home or Community Living Arrangement.
6. Medically related services that are not allowable by State law, rules, and regulations.
7. Services that duplicate or are provided at the same time of the same day as Community Living Support 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. Non-covered health maintenance activities as defined in the Rules and Regulations for Proxy Caregivers Used in Licensed Healthcare Facilities, Chapter 111-8-100.
10. 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.
2608 Basis for Reimbursement
Reimbursement Rate: Reimbursement rates for Respite services are found in Appendix A.
A. The unit of service is 15 minutes or overnight.
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B. Unit Limits:
1. 24 fifteen-minute units per day.
2. 889 fifteen-minute units per year or 39 overnight units per year.
C. Each overnight billing decreases the annual fifteen-minute maximum by 24 units.
D. Once a participant uses the annual maximum of fifteen-minute units, no additional Respite Services are billable for that participant for the remainder of the fiscal year.
E. $3,744 annual maximum.
Self-Directed and applies to 15 minutes, not overnight Respite
Respite: 1 unit = $1.00
Annual limit is as authorized in the individual budge up to the annual maximum of $3,744.
2609 Participant-Direction Options
A. Participants can choose the self-direction option with Respite 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 Respite Services.
C. For details on participant-direction, see Part II Policies and Procedures for COMP, Chapter 1200.

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