PART II – CHAPTER 600 SPECIAL CONDITIONS OF PARTICIPATION

1. General

The State of Georgia believes it is critical that services and supports respect the vision of the individual. Each agency or organization must incorporate this belief into their service delivery to support individuals with intellectual and developmental disabilities in living a meaningful life in the community. Specifically, the provider must ensure:

1. Person centered service planning and delivery that address what is important to and for individuals

2. Capacity and capabilities, including qualified and competent providers and staff

3. Participant safeguards

4. Satisfactory participant outcomes

5. Participants rights and responsibilities

6. Participant access

601.1 OUTCOMES FOR PERSONS SERVED

The Standards that follow are applicable to the Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD) or organizations that provide services to individuals that are financially supported in whole or in part by funds authorized through DBHDD, regardless of the age or disability of the individual served, and therefore applicable to providers of COMP services.   Participant self-determination includes freedom, authority and responsibility and is considered key to achieving the vision of a satisfying, independent life with dignity and respect for everyone.

Services, supports, care or treatment approaches assist the individual in:

1. Living in the most integrated community setting appropriate to their individual requirement, preferences and level of independence;

2. Exercising meaningful choices about their living environments, providers of services received, the types of supports , and the manner by which services are provided; and

3. Obtaining quality services in a manner as consistent as possible with community living preferences and priorities; and

4. Inclusion and active community integration are supported and evident in documentation.
Individualized services, supports, care and treatment determinations are made on the basis of an assessment of needs with the individual. The purpose of the assessment is to determine the individual’s hopes, dreams or vision for their life and to determine how best to assist the individual in reaching those hopes, dreams or vision including
determining appropriate staff to deliver these services.

1. Assessments should include but are not limited to the following:

a. The individual’s:

i. Hopes and dreams or personal life goals;

ii. Perception of the issue(s) of concern;

iii. Strengths;

iv. Needs;

v. Abilities; and

vi. Preferences.

b. Medical history;

c. A current health history status report or examination in cases where:

i. Medications or other ongoing health interventions are required;

ii. Chronic or confounding health factors are present;

iii. Medication prescribed as part of DBHDD services has research indicating necessary surveillance of the emergence of diabetes, hypertension, and/or cardiovascular disease;

iv. Allergies or adverse reactions to medications have occurred; or

v. Withdrawal from a substance is an issue.

d. Appropriate diagnostic tools such as impairment indices, psychological testing or laboratory tests;

e. Social history;

f. Family history;

g. School records (for school-aged individuals);

h. Collateral history from family or persons significant to the individual if available.

NOTE: When collateral history is taken, information about the individual may not be shared with the person giving the collateral history unless the individual has given specific written consent; and

j Review of legal concerns including
i. Advance Directives;

ii. Legal Competence;

iii. Legal Involvement of the courts; and

iv. Legal status as adjudicated by a court

2. Additional assessments should be performed or obtained by the provider if required to fully inform the services, supports, care and treatment provided. These may include but are not limited to:

a. Assessment of trauma or abuse;

b. Suicide risk assessment;

c. Functional assessment;

d. Cognitive assessment;

e. Behavioral assessments;

f. Spiritual assessment;

g. Assessment of independent living skills;

h. Cultural assessment;

i. Recreational assessment;

j. Educational assessment;

k. Vocational assessment; and

l. Nutritional assessment.

The policies, procedures and the conditions related to participation in Georgia’s Comprehensive Supports Waiver Program (COMP) to provide home and community-based waiver services for persons with intellectual and developmental disabilities (I/DD) are authorized by an approved waiver from the Centers for Medicare and Medicaid Services (CMS) pursuant to Section 2l76 of Public Law 97-35. The waiver provides for services to eligible individuals with I/DD who resides in or is at risk of an Intermediate Care Facility for Persons with Intellectual Disabilities (ICF/ID) placement.

In addition to the policies and procedures in this manual, providers must adhere to the following:

1. Those conditions for participation in the Medical Assistance Program, which are, outlined in Part I Policies and Procedures for Medicaid/PeachCare for Kids Manual applicable to all Medicaid providers;

2. Any policies and procedures specific to the COMP services rendered by the provider in the Part III COMP Manual; and

3. All applicable Standards for Department of Behavioral Health, Developmental Disabilities (DBHDD) in the DBHDD provider manual.

The COMP Program provides the following services to participants:

(1) Adult Occupational Therapy
(2) Adult Physical Therapy
(3) Adult Speech and Language Therapy
(4) Behavioral Supports Consultation
(5) Community Access
(6) Community Guide
(7) Community Living Support
(8) Community Residential Alternative
(9) Environmental Accessibility Adaptation
(10) Financial Support Services
(11) Individual Directed Goods and Services
(12) Natural Support Training
(13) Prevocational Services
(14) Respite
(15) Specialized Medical Equipment
(16) Specialized Medical Supplies
(17) Support Coordination
(18) Supported Employment
(19) Transportation
(20) Vehicle Adaptation

See Chapter 900, Section 901 of this manual for a definition of each service.

602. Organization and Administration

Providers enrolled in the Comprehensive Supports Waiver Program (COMP) services may be a local public or private agency or an individual provider that meets the Department of Community Health (DCH) and the Department of Behavioral Health and Developmental Disabilities (DBHDD) enrollment criteria.

Faith or Denominationally Based Organizations who receive Federal or State Monies address issues specific to being a Faith or Denominationally Based Organization in their Policies and Practice must include the following information and how it is shared with individual’s:

  • Its religious character;
  • The individual’s freedom not to engage in religious activities;
  • Their right to receive services from an alternative provider;
  • The organization shall, within a reasonable time after the date of such objection, refer the individual to an alternative provider.
  • If the organization provides employment that is associated with religious criteria, the individual must be informed.
  • In no case may federal or state funds be used to support any inherently religious activities, such as but not limited to:
    • Inherently religious activities;
    • Religious instruction; or
    • Proselytization
    • Organizations may use space in their facilities to provide services, supports, care and treatment without removing religious art, icons, scriptures or other symbols.

In all cases, rules found at 42 CFR Parts 54, 54a and 45 CFR Parts 96, 260 and 1050 Charitable Choice Provisions and Regulations: Final Rules shall apply.

603. Other Provider Information

603.1 Core Requirements

Providers serving COMP Program participants must be in compliance with applicable DBHDD Community Services Standards and Policies.

When Program Integrity or other focused audits are conducted by the Department of Community Health, the Department of Behavioral Health and Developmental Disabilities, and/or other regulatory agencies, and it is determined that there are unmet standards under ANY of the ‘critical function’ areas, the Department of Community Health authorizes the Department of Behavioral Health and Developmental Disabilities (DBHDD) to recommend adverse action that requires enrolled providers to correct deficiencies. DBHDD may recommend a suspension on new admissions, new services, or new sites or termination of the provider.

Noncompliance determinations in critical function areas may be cause for further adverse actions to be implemented, including suspension, recoupment of paid claims, and/or termination from the program. Additionally, failure to submit a Corrective Action Plan (CAP) will result in adverse action recommendations of suspension on new admissions, new services, new sites and /or recoupment of paid claims.

Critical function areas include:

  • Violation of Individual Rights, Responsibilities, and Protections
  • Inadequate Behavioral Support Practices
  • Violation of Adequate and Competent Staff (including Inadequate Staff to Participant Ratios and Service Provision)
  • Inadequate Medications and Healthcare Management
  • Violation of Respectful Service Environment (including Environmental Health and Safety)

603.2 Provider Information Documentation Requirements

Unless otherwise specified, materials cited below need not be submitted to the Department of Community Health (DCH), Division of Medicaid (DMA). They must be available for review at the agency or individual provider site.

A. Disclosure of Ownership – If the provider organization is a corporation, information on all ownership interests of five percent or more (direct or indirect) must be available for review.

B. Governing Body – The provider agency organization must have a governing body (or designated person(s) so functioning) which assumes full authority and responsibility for the operation of the COMP and for assuring compliance with all conditions of participation. A subdivision or subunit, which is required to meet independently the conditions of participation must have its own governing body.

C. Bylaws – The provider agency must have written and dated bylaws which are periodically reviewed and updated, as appropriate, by its governing body.

D. Reports – The provider shall furnish service reports to the Department of Behavioral Health and Developmental Disabilities in such form and at such
times as may be specified, which accurately and fully disclose all COMP activities.

E. Licensure – Licensure and other permits, when applicable, must be current and available at the agency or by the individual provider and open to view by the public.

F. Records Management – All required records pertaining to the provision of COMP services shall be maintained in accordance with standards specified in this manual, in the Department of Behavioral Health and Developmental Disabilities Provider Manual, and with accepted professional standards and practices. Such records shall be subject to inspection and review by the Department and its agents, and must be made available during the provider’s normal business hours (7:30 am – 5:00 pm).

G. Each provider must participate in the Department of Behavioral Health and Developmental Disabilities statewide participant data reporting system.

H. Each provider must participate in revenue and expenditure reporting on the Uniform Accounting System (UAS), maintenance of subsidiary expense ledgers, and specialized records for cost accounting purposes.

603.3 Provider Requirements for Accreditation and DBHDD Standards Quality Review

A. General Information:

1. Providers of COMP Services must meet requirements related to Accreditation and Quality Review of Standards for Providers of Developmental Disabilities Services in the DBHDD Standards Provider Manual, Policy Section. The manual is accessed as follows: www.dbhdd.georgia.gov.

2. There are some DD services that are not required to be accredited or to complete the Standards Quality Review process. These include:

a. Support Coordination

b. Specialized Services which include Specialized Medical Equipment, Specialized Medical Supplies, Environment Accessibility Adaptation, and Vehicle Adaptation when one or more of these specialized services are the only service (s) being delivered by the organization.

B. Standards Quality Review for DD providers authorized to receive less than $250,000 annually

1. Standards Quality Review: The DBHDD Provider Performance

Unit conducts reviews regarding compliance with the Community Service Standards. Providers receive from DBHDD a Certificate of Standards Compliance for a period not to exceed two years. DD providers must maintain a current Certificate of Standards Compliance to provide services.

2. Additional expectations related to demonstrating Standards Compliance:

a. Compliance must be maintained for all DBHDD approved services.

b. Providers must be providing DD community services for a minimum of 12 months and have completed the DBHDD Standards review or be accredited to add new services/sites. If new services are approved, they will be included in the subsequent Standards Quality Review.

c. At any time, DBHDD may request a Special Standards Quality Review to assess a Provider’s Compliance with the Community Service Standards.

d. Providers terminated due to failure to comply with the Standards Quality Review may not make application to become a provider for a period of one (1) year.

e. If during the standards quality review or a special standards quality review, critical function areas are identified, then the contracting regional office(s) has the option to relocate the individual(s) immediately.

C. Accreditation for DD Providers Authorized to Receive An Annual Amount Equal to or more than $250,000 annually

1. General expectations regarding Accreditation:

(a) It is the responsibility of the Provider to select an accrediting agency from the list listed in Appendix I and submit an Application for accreditation. This must occur within 30 days after the Provider has crossed the threshold and is authorized to receive funding in an amount more than $250,000 per year, regardless of expiration date of existing standards compliance certificate.
(b) The Provider is responsible for paying accreditation fees and providing to DBHDD Regional Coordinator a copy of the Accrediting body’s letter confirming the date of the survey.
(c) The Provider must be accredited within 12 months of application for accreditation.
(d) The provider must submit to DBHDD Regional Coordinator results of accrediting body visit within seven (7) working days of receipt.
(e) The provider is expected to ensure that the specific services approved by DBHDD are properly accredited.
(f) If DBHDD approves the Provider to offer new service, the Provider must be accredited for the new category of service at the time of their next accreditation survey. If the provider’s next accreditation survey is not due for longer than twelve (12) months from the time that the additional services are initiated by the provider, DBHDD may require the following:

i. that the Provider Performance Unit conducts a Special Standards Quality Review,
OR
ii. that the Provider verifies compliance with their accrediting body’s requirements related to accrediting the new service.

2. Maintenance of Accreditation and Request for Waiver

If an accredited provider loses accreditation, fails to reapply for accreditation, or comes under a corrective action requirement with Accrediting body, the provider must notify DBDDD within 7 working days; this notification is done in writing via a letter sent to:
a. DBHDD Regional Office

b. DBHDD Provider Network Management, Suite 23-247, 2 Peachtree Street, Atlanta GA 30303 AND

c. DBHDD Contracts Section, Suite 23-173, 2 Peachtree Street, Atlanta, GA 30303

3. Action related to each of the following situations
a. Loss of Accreditation: Loss of accreditation results in termination of the DBHDD relationship with the provider.

b. Failure to reapply will result in actions being taken against the provider. The provider will be given sixty (60) calendar days, during which the agency makes application, payment and a scheduled visit date by accreditation body. Failure to meet this time frame results in termination of the DBHDD relationship with the provider.

604. Provider Enrollment

604.1 To Enroll to Become a Provider

A. To enroll to become a provider agency or individual must complete DBHDD Policy and Procedure on Becoming a Provider of Developmental Disabilities Services. The Policy is found in Recruitment and Application to Become a Provider of Developmental Disabilities Services, located at the following website:http://gadbhdd.policystat.com.

B. The Medicaid Provider Enrollment packet is obtained from the following website: www.mmis.georgia.gov or by calling (800) 766-4456 for assistance.

Both applications are submitted to the address listed in the DBHDD provider application.

C. Questions regarding licensure requirements should be directed to the Department of Community Health, Healthcare Facility Regulation Division (HFR), formerly known as the Office of Regulatory Services, at 1-800-georgia or the website: www.dch.georgia.gov.
1. The Department requires proof of licensure or permit for the following
services:

Adult Occupational Therapy Services
Adult Physical Therapy Services
Adult Speech Language Therapy Services
Community Living Support
Community Residential Alternative
Respite Services

2. A proof of licensure is required from individual providers as defined for specific services in the Part III COMP Manual at the website: www.mmis.georgia.gov

D. Individual professionals making application to provide any of the following services should follow the information provided in Section 604.1 in submitting an individual provider application:
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Rev. 04 2011

Adult Occupational Therapy Services
Adult Physical Therapy Services
Adult Speech and Language Therapy Services
Behavioral Supports Consultation Services
Community Living Support LPN Services
Rev. 04 2010
Rev. 01 2011
Community Living Support RN Services
Community Residential Alternative LPN Services
Community Residential Alternative RN Services

Rev. 10 2011
Individuals applying to be enrolled Medicaid providers must have provided the waiver service for at least one year as an individual hired by a participant or representative through self-direction prior to submission of a provider application. The individual provider must provide evidence of satisfactory performance of self-directed waiver service through documentation from the support coordination agency (such as support coordination monitoring notes) and other sources (such as no evidence of substantiated critical incidents against the individual in the provision of self-directed services or required correction actions related to the provision of self-directed services by the individual). Policies and procedures related to self-direction are in Chapter 1200 of this manual.

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Rev. 04 2011
E. Initial provider applications for Community Residential Alternative

Services (CRA) are limited to three (3) residential sites (Community Living Arrangement).

F. Providers with approval to provide Community Residential Alternative Services at the initially approved one to three site(s) can not apply to add additional sites or service, for one year and until the agency has completed the DBHDD Community Service Standards Quality Review or met accreditation.

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Rev 01 2013
G. Providers must be providing DD community services for a minimum of 12 months and have completed the DBHDD Standards review or be accredited to add new services/sites.

H. Providers who apply to provide Community Residential Alternative Services in the host home/life sharing arrangement must be a currently approved agency provider of CRA services in a Personal Care Home or Community Living Arrangement or be an agency that only serves individuals under the age of 19 years and holds a Child Placing Agency license.

I. Provider agencies that apply or are enrolled to provide Financial
Support Services (FSS) can not apply or be enrolled to provide any other
waiver service. Application for enrollment for FSS are submitted directly
to the Department of Community Health.

J. Provider agencies that apply or are enrolled to provide Support
Coordination Services can not apply or be enrolled to provide any
other waiver service.

Rev. 04 2011
K. The Georgia Department of Behavioral Health and Developmental Disabilities Regional Office staff conducts preliminary site visits as required.

License(s) (as applicable)

1. Community Living Arrangement License (that serves exclusively two to four adults who are receiving services authorized or financed, in whole or in part, by the Georgia Department of Behavioral Health and Developmental Disabilities).
Or

Child Placing Agency License (for agency providing community residential alternative services provided in host home/life sharing arrangements for participants under the age of 19 years)

2. Private Home Care License (for agency providing

community living support and in-home respite services)
Or
Home Health Agency License (for home health agency
providing adult therapy services)
Or

Individual Professional Licenses (for individuals and
agencies for nursing, occupational therapy, physical therapy,
speech and language therapy, and other professional services
as required for specific COMP services).

Personal Care Home Permit, Community Living Arrangement Permit, Child Caring Institutions for 4 beds and Child Placing Agencies (for the provision of Respite Services only)
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3. Personal Care Home (PCH) permits are not accepted for applications to provide Community Residential Alternative (CRA) Services. A CLA license is required for these applications.

L. Current Secretary of State Registration
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Rev 01 2013

M. Current Business License or Permit

604.2 Approval of New Providers
Rev. 04 2011

1. HP Enterprise (HPES) reviews and sends an approval letter with a provider number and corresponding approved service name(s) to the provider.

2. DBHDD issues a Letter of Agreement to agencies approved by DCH to provide COMP service.
Rev 01 2013

Rev. 04 2011
605. Changes in Enrollment Information

Enrolled providers are required to provide written notice to the DCH, DBHDD, Healthcare Facility Regulation (as applicable), and Support Coordination.

A. Notification of Updated Information
1. Should the information submitted during enrollment (e.g. office location, the payee, etc.) change, the provider must report those changes within ten (10) calendar days of the changes in writing to the following:

Provider Enrollment Unit
Office of Provider Network Management
Georgia Department of Behavioral Health and Developmental Disabilities
2 Peachtree Street, Suite 23-247
Atlanta, Georgia 30303

AND

Program Specialist, NOW/COMP Waivers
Department of Community Health
2 Peachtree Street, 37th Floor
Atlanta, GA 30303

2. The Department of Community Health will verify information as needed and provide notification to HP Enterprise for claims system updates. Notice of a change of information is not accomplished by simply including the updated information on claims submitted for payment. These claims will be made to the payee on file. Checks returned to the Division by the Post Office will be voided.

Reported changes should include all of the following applicable items or any other pertinent information:

a. Address of the provider agency, administrative or business office
b. Address of the service location
c. Request to deactivate provider number
d. Request to reactivate suspended provider number
e. Request to terminate provider number
f. Telephone numbers
g. Changes in permit/license issued by Healthcare Facility Regulation
h. Other changes as outlined in Part I, Chapter 100, Section 105.7.

605.1 Process for Provider Enrollment Application for Facilities

Effective September 1, 2014, DCH will only accept online Medicaid enrollment applications for facilities, including additional locations. In extreme hardships cases, DCH may waive this requirement for the Comprehensive Supports Waiver Program providers; this request must be in writing and submitted to the Department of Behavioral Health and Developmental Disabilities (DBHDD) Provider Network Unit. DBHDD will submit the request to DCH Provider Enrollment for consideration. Facility applicants must enroll online by clicking on Provider Enrollment/Enrollment Wizard. The Enrollment Wizard will assist with the completion of an application. Facilities eligible to enroll using an additional Location must first log onto the web portal. A web base training module is located on the website @ www.mmis.georgia.gov. The training module is located under the Provider Information link.
Rev. 10 2014

606. Staffing Requirements
Rev 01 2013

Individuals are provided Services and Supports by Staff who are properly Licensed, Credentialed, Trained and who are Competent.

606.1. Agency Staffing

A. Organizational policy and practice demonstrates that appropriate professional staff conduct the following services and supports, including but not limited to:
Rev 10 2013
1. Overseeing the services, supports, care and treatment provided to individuals;

2. Supervising the formulation of the individual service plan or individual recovery plan;

3. Conducting diagnostic, behavioral, functional and educational assessments;

4. Designing and writing behavior support plans

5. Implementing assessment, care and treatment activities as defined in professional practice acts; and

6. Supervising high intensity services such as screening or evaluation, assessment, residential behavioral support services.
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B. The type and number of professionals staff and all other staff attached to the organization are:
1. Properly trained, licensed or credentialed in the professional field as required;

2. Present in numbers to provide adequate supervision to staff;

3. Present in numbers to provide services, supports, care and treatment to individuals as required;

4. Experienced and competent to provide services supports, care and treatment and/or supervision as required;

5. In 24 hour or residential care settings, at least one staff trained in Basic Cardiac Life Support (BCLS) and first aid is on duty at all times on each shift; and

6. DD Providers using Proxy Caregivers must receive training that includes knowledge and skills to perform any identified specialized health maintenance activity.

Rev 10 2011
C. The organization must have procedures and practices for verifying licenses, credentials, experience and competence of staff:
Rev 10 2013
1. There is documentation of implementation of these procedures for all staff attached to the organization; and
2. Licenses and credentials are current as required by the field.
D. When medical and/or psychiatric services involving medication are provided, the organization receives direction for that service from a professional with experience in the field, such as medical director, physician consultant, or psychiatrist.
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E. Federal law, state law, professional practice acts and in-field certification requirements are followed regarding:
1. Professional or non-professional qualifications required to provide the services offered. If it is determined that a service requiring licensure or certification by State Law is being provided by unlicensed staff, it is the responsibility of the organization to comply with DBHDD Policy regarding Licensing and Certification Requirements and the Reporting of Practice Act Violations;

2. Laws governing hours of work such as but not limited to the Fair Labor Standards Act
F. Job descriptions are in place for all personnel that include:
1. Qualifications for the job;
2. Duties and responsibilities;
3. Competencies required;
4. Expectations regarding quality and quantity of work; and
5. Documentation that the individual staff has reviewed understands and is working under a job description specific to the work performed within the organization.
Rev 10 2013
G. a) There is evidence that a national criminal records check (NCIC) is completed for all employees, to include contractors/subcontractors and their employees, and volunteers who work directly with the individuals, who provide services, supports, care and treatment to persons served within the organization. The applicant should submit fingerprints prior to employment or if circumstances justify delay, within 10 business days of the employee’s start date. See DBHDD Criminal History Records Checks for Contractors Policy 04-104
https://gadbhdd.policystat.com/policy/201763/latest/.
b) There is mandatory disqualification from providing services for DBHDD for a minimum of five (5) years from the date of conviction, a plea of nolo contendere, or release from incarceration or probation, whichever is later. Refer to DBHDD Policy 04-104, Criminal History Records Checks for Contractors for a list of crimes that restricts employment as a DBHDD contractor or contractor’s employee.

H. The organization has policies, procedures and documentation practices detailing all human resources practices, including but not limited to:
Rev 10 2013
a. Process for determining staff qualifications including:
i. License or certification status;

ii. Training;

iii. Experience; and

iv. Competence.

b. Processes for managing personnel information and records which should include but not be limited to:

i. Criminal records checks (including process for reporting CRC status change);

ii. Drivers license checks; and

iii. Annual TB testing (for all staff providing direct support).

c. Provisions for and documentation of:

i. Timely orientation of personnel;

ii. Periodic assessment and development of training needs;

a) Development of activities responding to those needs; and

iii. Annual work performance evaluations.
d. Provisions for sanctioning and removal of staff when:
i. Staff is determined to have deficits in required competencies;
ii. Staff is accused of abuse, neglect or exploitation.
e. Administration of personnel policies without discrimination.

I. All staff, direct support volunteers, and direct support consultants shall be trained and show evidence of competence in the following;
Rev. 01 2010
Rev 10 2013
a. Orientation requirements are specified for all staff and are prior to direct contact with individuals and are as follows:
i. The purpose, scope of services, supports, care and treatment offered including related policies and procedures;
ii. HIPAA and Confidentiality of individual information, both written and spoken;
iii. Rights and responsibilities of individuals;
iv. Requirements for recognizing and mandatory reporting suspected abuse, neglect or exploitation of any individual:
a) To the Georgia Department of Behavioral Health and Developmental Disabilities;
b) Within the organization;
c) To appropriate regulatory or licensing agencies (Healthcare
Facility Regulation) and for in home services (Adult Protective Services); and
d) To law enforcement agencies.
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J. Within the first (60) sixty days from date of hire, all staff having direct contact with participants shall receive the training in the following which shall include, but not be limited to:
1. Person centered values, principles and approaches;

2. A Holistic approach for providing care, supports and services for the individual;

3. Medical, physical, behavioral and social needs and characteristics of the persons served;

4. Human rights and responsibilities (*);

5. Promoting positive, appropriate and responsive relationships with persons served, their families and stakeholders;

6. The utilization of:
i. Communication skills (*);

Rev. 01 2013
ii Behavioral Support and Crisis Intevention techniques to de-escalate challenging and unsafe behaviors (*);
iii Nationally benchmarked techniques for safe utilization of emergency interventions of last resort (if such techniques are permitted in the purview of the organization);
Rev 10 2013
iv. The Georgia Crisis Response Systems (GRCS)
7. Ethics, cultural preferences and awareness;
8. Fire safety (*);
9. Emergency and disaster plans and procedures (*);
10. Techniques of standard precautions, including:
i. Preventative measures to minimize risk of HIV;
ii. Current information as published by the Centers for Disease Control (CDC); and
iii. Approaches to individual education.
11. BCLS including both written and hands on competency training is required;
Rev 01 2013
12. First aid and safety;
13. Specific individual medications and their side effects (*);
14. Suicide Prevention Skills Training (such as AIM, QPRP); and
15. Ethics and Corporate Compliance is evident.
16. A minimum of 16 hours of training must be completed annually to include the trainings noted by asterisk (*) in items 4, 6, 8, 9, and 13 above.
17. The organization details in policy by job classification:
i. Training that must be refreshed annually;
ii. Additional training required for professional level staff;
iii. Additional training required for all other staff.
18. Regular review and evaluation of all staff is evident at least annually
i. The evaluation should occur annually;
ii. Managers who are clinically, administratively and experientially qualified conduct evaluations.
19. It is evident that the organization demonstrates administration of personnel policies without discrimination.

607. WAIVERS TO STANDARDS

The organization may not exempt itself from any of these standards or any portion of the provider manual. Individual standards and provider manual requirements may be requested to be waived by written request to the Regional Coordinator for the Georgia Department of Behavioral Health and Developmental Disabilities. For any request, approval must be given, in writing, by the:

1. DBHDD Regional Coordinator or designee

2. Assistant Commissioner of Developmental Disabilities or designee

607.1 Procedures for Requests of Waivers of Standards

The Department of Human Behavioral Health and Developmental Disabilities (DBHDD) has a standard process for review and approval of requests for waivers of standards that are listed below.

A service provider may request that the facility capacity limit be waived when the standard creates an undue hardship or barrier for participants to access a needed service.

A service provider may not request the waiving of any standards that pertain to Healthcare Facility Regulation (HFR) licensing requirements or the definition of a Developmental Disability Professional (DDP). Requests to waive these standards will not be reviewed by DBHDD.
Rev 07 2013

A service provider, individual, family member, advocate, or other interested party may request that a standard be waived when the standard creates an undue hardship or barrier for individuals to access a needed services. Waiver requests are sent to the DBHDD Regional Coordinator or designee, accompanied by a completed Request for Waiver of Standards Form and other applicable Waiver of Standards Requests form(s) for the specific request (available online at DBHDD PolicyStat, http://gadbhdd.policystat.com). The Request for Waiver of Standards Form includes relevant information related to the request for a waiver of standards:
Rev 07 2013
. Justification of the reason for a waiver of standards due to an undue hardship or barrier for participants to access a needed service;

. Plan for improvement or changes needed in order for services to be available in accordance with the standards;

. A recommendation and affirmation of the identified need for a waiver signed by the Director of the provider organization.

607.2 Process for Review and Approval of Waivers of Standards

1. Providers are required to submit all NEW waiver of standard requests to the DBHDD Regional Office no later than forty-five (45) days prior to projected start date.

2. Providers are required to submit RENEWAL waiver of standard requests to the DBHDD Regional Office no later than sixty (60) days prior to the expiration date.

3. The Regional Office completes an initial review to determine if the request falls within DBHDD guidelines. Requests for WOS are reviewed by the Regional Coordinator or the Regional Service Administrator (RSA) for Developmental Disabilities as the designee.

4. Within ten (10) business days after receiving a waiver request, the DBHDD Regional Coordinator or designee submits the request, along with his/her recommendations, to the appropriate DBHDD State Disability Office. The recommendation is documented on the Tracking Form for Request for Waiver of Standards (available online at DBHDD PolicyStat, http://gadbhdd.policystat.com) and submitted to the Division of Developmental Disabilities with the request.

5. The Division of Developmental Disabilities approves or disapproves the requested waiver within thirty (30) calendar days after involving appropriate DBHDD staff in the review of the request.

6. Should the Provider fail to submit the information needed to review the request or the Regional Office and/or Division of Developmental Disabilities requires more information from the Provider and there is a delay in additional or resubmission of information, this will cause a delay in response by the Regional Office and/or Division of Developmental Disabilities.

7. The Division of Developmental Disabilities is responsible for notifying the provider (or other requesting party) by letter of the decision that has been made. The letter outlines the decision regarding the waiver request; if the request is approved, the expectations for the provider (or other requesting party) are outlined. The letter created by the Division is forwarded to the Regional Coordinator for distribution to the Provider.

8. The Division of Developmental Disabilities maintains a record of the information regarding the waiver request using the Tracking Form for Request for Waiver of Standards (available online at DBHDD PolicyStat, http://gadbhdd.policystat.com) which is then stored in the DBHDD Shared Drive or using a database created by the Disability Office for this purpose.

9. In extraordinary circumstances, the Regional Office may request an expedited review of a NEW waiver of standard due to a situation impacting the health and safety of an individual.

10. All approved DD waivers expire at the end of the specified approved time period, not to exceed one (1) year following approval.

11. If the petitioner believes there are special circumstances justifying an extension beyond one year, they may apply again prior to the expiration date, completing another Request for Waiver of Standards form with updated documentation.
607.3 Provider Responsibilities Following Approval of a Waiver Request

1. The provider must maintain on file a copy of all approved waiver requests and have such waiver(s) available for review by the State.

2. The provider must notify the Regional Coordinator or designee when there is any change to services for which the waiver was requested.

3. For waivers of standards for services that are audited/monitored by DBHDD or Department of Community Health contracted entities, the provider must produce a copy of the waiver letter at the time of the audit in order for the DBHDD reviewer;

4. External Review Organization or other contracted entity is to appropriately incorporate the approved waiver into the audit/monitoring activity.
Waiver Requests for More than One Year

All approved waivers expire at the end of one year following their approval. If the petitioner believes there are special circumstances justifying an extension beyond one year, they may apply again prior to the expiration date, completing another Request for Waiver of Standards Form with updated documentation.

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