901. Services Overview
All services provided under the Comprehensive Supports Waiver Program (COMP) are based on the assessed need of the participant that includes consideration of what is important to and for the person, person-centered planning/thinking, and the use of person-centered tools (see COMP Part II, Appendix P for information on person-centered planning). These reimbursable services include the following and are as specified in the approved ISP:
a. Adult Occupational Therapy – these services address the occupational therapy needs of the adult participant that result from his or her developmental disabilities.
b. Adult Physical Therapy – these services address the physical therapy needs of the adult participant that result from his or her developmental disabilities.
c. Adult Speech and Language Therapy – these services address the speech and language therapy needs of the adult participant that results from his or her developmental disabilities.
d. Behavioral Supports Consultation – these services are the professional level services that assist the participant with significant, intensive challenging behaviors that interfere with activities of daily living, social interaction, work or similar situations.
e. Community Access – these services are designed to assist the participant in acquiring, retaining, or improving self-help, socialization, and adaptive skills required for active participation and independent functioning outside the participant’s place of residence.
f. Community Guide – these services are only for participants who opt for participant direction and assist these participants with defining and directing their own services and supports and meeting the responsibilities of participant direction.
g. Community Living Support – these services are individually tailored supports that assist with the acquisition, retention, or improvement in skills related to a participant’s continued residence in his or her family home.
h. Community Residential Alternative – these services are targeted for people who require intense levels of residential support in small group settings of four or less, foster homes, or host home/life sharing
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arrangements and include a range of interventions with a particular focus on training and support in one or more of the following areas: eating and drinking, toileting, personal grooming and health care, dressing, communication, interpersonal relationships, mobility, home management, and use of leisure time..
i. Environmental Accessibility Adaptation – these services consist of physical adaptations to the participant’s of family’s home which are necessary to ensure the health, welfare, and safety of the individual, or which enable the individual to function with greater independence in the home.
j. Financial Support Services – these services are provided to assure that participant directed funds outlined in the Individual Service Plan are managed and distributed as intended.
k. Individual Directed Goods and Services – these services are not otherwise provided through the COMP or Medicaid State Plan but are services, equipment or supplies identified by the participant who opts for participant direction and his or her Support Coordinator or interdisciplinary team.
l. Natural Support Training – these services provide training and education to individuals who provide unpaid support, training, companionship or supervision to participants.
m. Prevocational Services – these services prepare a participant for paid or unpaid employment and include teaching such concepts as compliance, attendance, task completion, problem solving and safety.
n. Respite – these services provide brief periods of support or relief for caregivers or individuals with disabilities and include maintenance respite for planned or scheduled relief or emergency respite for a participant requiring a short period of structured support (typically due to behavioral support needs) or due to a family emergency.
o. Specialized Medical Equipment – this equipment consists of devices, controls or appliances specified in the Individual Service plan, which enable participants to increase their abilities to perform activities of daily living and to interact more independently with their environment.
p. Specialized Medical Supplies – these supplies consist of food supplements, special clothing, diapers, bed wetting protective chunks, and other authorized supplies that are specified in the Individual Service Plan.
q. Support Coordination – these services are a set of interrelated activities for identifying, coordinating, and reviewing the delivery of appropriate services with the objective of protecting the health and safety of participants while ensuring access to needed waiver and other services.
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r. Supported Employment – these services are supports that enable participants, for whom competitive employment at or above the minimum wage, is unlikely absent the provision of supports, and who, because of their disabilities, need supports to work in a regular work setting.
s. Transportation – these services enable participants to gain access to waiver and other community services, activities, resources, and organizations typically utilized by the general population but do not include transportation available through Medicaid non-emergency transportation or as an element of another waiver service; and
t. Vehicle Adaptation – these services include adaptations to the participant’s or family’s vehicle approved in the Individual Service Plan, such as a hydraulic lift, ramps, special seats and other modifications to allow for access into and out of the vehicle as well as safety while moving.
Part III, Policies and Procedures for the Comprehensive Supports Waiver (COMP) Program provides the service requirements specific to the individual COMP Services. Description of each service is discussed more fully in Part III Policies and Procedures for COMP, Chapters 1300-2900. The general service requirements for the COMP Program are specified in the section to follow.
Participants have the option to self-direct COMP services, with the exception of Community Residential Alternative Services, Financial Support Services, Prevocational Services, and Support Coordination. The Co-Employer Participant-Direction Option is available for Community Access, Community Guide, Community Living Support, Supported Employment, and Transportation Services. For details on participant-direction, refer to Part II Policies and Procedures for COMP, Chapter 1200.
902. Exclusions and Special Conditions
A. Payment directly or indirectly for any waiver services provided to participants by legally responsible relatives, such as spouses, parents of minor children, or legal guardians, when the services are those that these persons are already legally obligated to provide is prohibited in this waiver. Direct payment is defined as a payment made to the legally responsible individual without any diversion. Indirect payments occur when a payment is made to a recipient, a provider, or a third party, and then transferred to the legally responsible individual or approved family paid caregiver. Other participants’ family members, by blood or marriage, who are aged 18 years or older, may be reimbursed for providing services when there are extenuating circumstances (family is defined as a person who is related by blood within the third degree of consanguinity or by marriage, such as spouse, stepparents, or stepsiblings. Third degree of consanguinity means mother, father, grandmother, grandfather, sister, brother, daughter, son, granddaughter, grandson, aunt, uncle, great aunt, great uncle, niece, nephew, grand niece, grand nephew, 1st cousins, once removed, and 2nd cousins). Extenuating circumstances include the following:
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1. lack of qualified providers in remote areas,
2. lack of a qualified provider who can furnish services at necessary times and places,
3. presence of extraordinary and specialized skills or knowledge by approvable relatives in the provision of services and supports in the approved ISP, and/or
4. clear demonstration of being the most cost effective and efficient means to provide the services.
NOTE: Approvable relatives meeting the extenuating circumstances criteria may provide Community Access, Community Living Support, Supported Employment, and/or Transportation Services in the COMP Program.
In the case of a parent of an adult requesting to provide waiver services, there must be a clear demonstration that the provision of the waiver services by the parent is in the best interest of the participant and that the above-required extenuating circumstances are met. In addition, whenever the parent of an adult is approved to provide waiver services under extenuating circumstances, the support coordinator for the participant assures at least an annual review of whether the continued provision of the waivered service is in the best interest of the participant.
The Division of Medicaid considers on a case-by-case basis if
extenuating circumstances justify approval of family members (other than
spouses, parents of minor children, or legal guardians) as paid caregivers of
traditional provider services. See Chapter 1200 for the policies on
extenuating circumstances review for provision of participant-directed services by
Requests for consideration of extenuating circumstances are to be made in writing and submitted to the appropriate DBHDD Regional Office (see Appendix A). The responsible party will receive written notification of the Department of Community Health’s final decision for traditional provider services furnished by relatives.
B. Medical, home health, dental, and pharmacy services that are provided under the Medicaid State Plan are not included as COMP services; however, the provider along with the Support Coordinator is expected to ensure the member is linked with all needed and appropriate services.
903. Duplication of Services
A. Waiver Programs include:
New Options Waiver (NOW)
Comprehensive Supports Waiver (COMP)
Community Care Services Program (CCSP)
Independent Care Waiver Program (ICWP)
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Waivered Home Care Services (Model Waiver)
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Service Options Using Resources in Community Environments (SOURCE)
GAPP (except skilled nursing)
B. COMP and other Waiver clients are not eligible to enroll in Medicaid HMOs.
904. Hospice Services
If an individual enrolled in the Comprehensive Supports Waiver Program is diagnosed with a terminal illness, he or she may elect to enroll in the Hospice program. He or she may continue to receive the following waiver services that are not duplicative of the hospice services:
Community Access Services
Community Residential Alternative Services
Request or claims for other waiver services while enrolled in the Hospice program will be denied.
When a COMP participant elects to enroll in the Hospice program, the hospice agency assumes full responsibility for the professional management of the individual’s hospice care in accordance with the hospice Conditions of Participation. When an individual enrolled in a waiver program elects hospice, the hospice agency, the waiver participant and the waiver participant case manager must communicate, establish, and agree upon a coordinated plan of care for both providers that reflects the hospice philosophy and is based on an assessment of the individual’s needs and unique living situation. The Hospice provider must coordinate care of the participant enrolled in other Medicaid programs, i.e., Home and Community-Based Waivers and Nursing Facilities, as evidenced in the participant’s hospice plan of care.
A. When a COMP participant elects Hospice services, a plan of care must be written and is consistent with the hospice philosophy of care. The plan of care must be written in accordance with the CFR and include the individual’s current medical, physical, psychosocial, and spiritual needs. The hospice must designate an RN from the hospice to coordinate the implementation of the
A participant may receive more than one service within a single waiver program, but a participant may not participate in more than one waiver program at any given time. Claims submitted for services rendered to the same participant under more than one Waiver Program will be denied.
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plan of care.
B. Evidence of the coordinated plan of care must be in the clinical records of both providers. The waiver provider and the hospice must communicate with each other when any changes are indicated to the plan of care and each provider must be aware of the other’s responsibilities in implementing the plan of care.
C. All hospice services must be provided directly by hospice employees and cannot be delegated. The hospice may involve the waiver provider staff in assisting with the administration of prescribed therapies included in the plan of care only to the extent that the hospice would routinely utilize the services of the patient’s family/caregiver in implementing the plan of care.
The waiver provider must offer the same service to its participant who has elected the hospice benefit as it furnishes to its participants who have not elected the hospice benefit. The participant receiving hospice services should not experience any lack of these services because of his or her status as a hospice program member.
905 Transportation Requirements
A. Individual and agency providers that provide transportation as a part of a waiver service specified in the COMP Part III manual must meet the following requirements:
1) Be legally licensed in the State of Georgia with the class of license appropriate to the vehicle operated if transporting participants as follows:
i.Have a valid, Class C license as defined by the Georgia Department of Driver Services for any single vehicle with a gross vehicle weight rating not in excess of 26,000 pounds.
ii.Have valid, Commercial Driver’s License (CDL) as defined by the Georgia Department of Driver Services if the vehicle operated falls into one of the following two classes:
1. If the vehicle has a gross vehicle weight of 26,001 or more; or
2. If the vehicle is designated to transport 15 or more passengers, including the driver.
2) Have no more than two chargeable accidents, moving violations, or any DUIs in a three (3) year period within the last five (5) years of the seven (7) year Motor Vehicle Record (MVR) period if transporting participants.
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906 Day Services Requirements
The delivery of day services to include Community Access, Prevocational, and Supported Employment services must be based on the participant’s needs and outlined in the Individual Services Plan. Any variation from the Individual Service Plan should be considered noncompliance and will be reported as such.
907 Developmental Disability Professional Requirements
DDP services rendered by a provider agency must be provided by a qualified individual DDP employed by, or under professional contract with, the provider agency.
At least one agency employee or professional under contract with the agency must:
Be a Developmental Disability Professional (DDP)
Have responsibility for overseeing the delivery of waiver services to participants.
The same individual may serve as the agency director, nurse and/or DDP, provided the employee meets the qualifications and/or designation of each position. However, the duties of shared roles for each position must be separately delivered and documented. Reporting of change in approved and designated DDP (addition or termination) is as indicated in the current state fiscal year DBHDD Provider Manual, Part II Standards for Developmental Disabilities Service Providers located at www.dbhdd.georgia.gov (For Providers, Community Provider Manuals, Provider Manual for Community Developmental Disabilities Providers).
Each Development Disability Professional (DDP) has a specified schedule or contract with sufficient hours per week to meet the duties of the DDP and level of need for individual receiving services, which includes but are not limited to:
1. Overseeing the services and supports provided to participants that include:
a. The agency DDP monitors and/or participates in the implementation and delivery of the Individual Service Plan (ISP).
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NOTE: The Department will allow an exception to Out-of-State Driver’s License and MVP record under the following circumstances: (1) the individual is on active duty in Georgia; (2) the individual is a college student enrolled at a Georgia college or university; or (3) the individual’s place of residence is a neighboring state on the border of Georgia. For individual to be granted this exception, he or she must:
a. Have a valid, Class C license
b. Have no convictions for substance abuse, sexual crime or crime of violence for five (5) years prior to providing the service
c. Have current, valid insurance
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b. The agency DDP supervises the delivery of service and ensures the strategies reflect the goals and objectives of the ISP.
c. The agency DDP monitors the progress toward achievement of goals in the ISP, and makes recommendations, as appropriate
2. Supervising the formulation of the participant’s plan for delivery of all waiver services provided to the participant by the provider, on an annual basis subsequent to ISP development and after any ISP addendum that includes, but is not limited to:
a. Ensuring the implementation strategies reflect the ISP and the needs of the participant
b. The agency DDP participates in the development of the ISP as indicated by signature of the ISP
3. Conducting or overseeing functional assessments to support formulation of the participant’s plan for delivery of all waiver services as indicated by the DDP signature:
a. The Health Risk Screening Tool;
b. The Supports Intensity Scale;
c. Functional Behavioral Analysis; if qualified
d. And others as needed or required.
4. Supervising high intensity services that address health and safety risks for the participants as indicated by the DDP signature:
a. The agency DDP is involved in reviewing and/or writing, and the implementation and effectiveness of the Behavior Support Plan
b. The agency DDP is involved in reviewing and/or writing, and the implementation and effectiveness of the Crisis Plan
c. The agency DDP is involved in identifying ongoing supports as needed (medical and/or behavioral) in collaboration with appropriate personnel
The provider will be responsible for monitoring and ensuring the DDP meets his/her above assigned responsibilities utilizing the below performance indicators.
Performance indicators of the responsibilities listed above (1-4) are as follows:
a. Active participation in the planning meeting documented in either the meeting minutes/notes and/or progress notes prior to ISP meeting.
b. Documented contact with the SC prior to the ISP date.
c. Consulted with, supervised, and provided guidance to direct support staff regarding implementation of the services.
d. The DDP will complete documentation in any individual’s record for any of the above responsibilities. This documentation shall include the
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signature, title/credentials, timed (start and end time of delivery of service) and date.
e. The DDP will complete, or assure the completion of required agency assessments, including but not limited to, HRST and SIS, within the given time frame.
For additional details regarding documentation requirements, refer to Chapter 1100 of this manual.
Hours scheduled and worked must be sufficient to meet the individual needs of each participant served by the provider. The provision of DDP oversight and service provision must be documented in the participant’s record. A DDP is not scheduled to work only on a PRN (pro re nata) basis.
The DDP personnel file must include the following:
a. A signed DDP job functions that meet the DDP requirements;
b. A specified schedule for each site and sufficient contract hours per week (not a PRN staff) to meet the individual’s needs of the assigned caseload must be maintained on site;
c. There is documentation of attestation by the DDP that the scheduled or contracted hours do not conflict with his/her work with another provider agency;
d. There is documentation to verify the DDP’s face to face visits of specified scheduled and contact hours in the individual’s record;
e. At a minimum, the DDP for residential services must document on a monthly basis, a review of each individual’s health, safety, ISP goals progress and any recommendations identified. Where applicable, the adequacy of high intensity services should be included;
f. For services other than residential such as Community Living Support Services and Community Access Services, DDP visits are documented as indicated in ISP; and
g. For individuals on exceptional rate, there is documentation of additional direct service provision and oversight by the DDP, if applicable.
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NOTE: DDP direct service provision and oversight for a participant with an approved exceptional rate is as specified in the letter of approval for the exceptional rate.
Required Training for Developmental Disabilities Professionals
The provider agency must also show participation and document the participation of each DDP in a minimum of eight (8) hours per year of DBHDD sponsored or other training in the area of developmental disabilities in addition to the initial orientation requirements for new employees listed in Chapter 600, Section 606. Other required trainings for DDPs in their first year of employment include:
Individual Service Planning
Support Intensity Scale overview
Health Risk Screening Tool on line training
908. Termination of Participant Services Requirements
The provider must provide a minimum of a 30 days notice when terminating COMP services to a participant. The provider must agree to be a part of the transition process with the support coordinator and DBHDD Regional Office and continue to provide COMP services until a new provider is identified and transition to this provider occurs in order to assure continuity of care and maintenance of health and safety for the participant.
909 Proxy Caregivers and Health Maintenance Activities
Licensed provider agencies, including co-employer agencies, must abide by the Rules and Regulations for Proxy Caregivers Used in Licensed Healthcare Facilities, Chapter 111-8-100. Proxy caregivers may be used under the following licensure categories:
Personal Care Homes
Community Living Arrangements
Assisted Living Communities
Residential Drug Abuse Treatment Programs
Traumatic Brain Injury Facilities
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CHAPTER 900 GENERAL SERVICES REQUIREMENTS
901. Services Overview